(11/02)
N. C. Department of Correction
Performance Appraisal Transfer Form
Employee’s Name: ____________________________________________________________________
First
M.I.
Last
Employee’s SS#: _____________________ Employee’s Position Title: _________________________
Dates Employed with DOC:
From: ____________________ To: _______________________
DOC Division: ______________________________
DOC Unit Name: ____________________________
Unit Telephone #: _______________________
Name of Employee’s Supervisor: __________________________________
Last Day Worked with Department of Correction: _____________________
Name of Agency the Employee is Transferring to: ____________________________________________
DOC Appraisal Information
The Employee’s Performance Cycle Dates: ____________________
___________________
Beginning Cycle Date Ending Cycle Date
Date of Work Plan Discussion: ______________________________
Action Taken by the Supervisor to Update Record before the Transfer (Check one):
Final Evaluation
Interim Review
Summary
Date Conducted: _____________________________
Rating Issued (Check one):
Outstanding
Very Good
Good
Below Good
Unsatisfactory
Comments:
____________________________________________________________________________________
NOTE: Please attach this form and the employee’s current performance cycle appraisal documents to
the DC-154S package.
INSTRUCTIONS: This form must be completed by the unit when a DOC employee transfers from DOC to
another state agency. Attach the employee’s Final Evaluation, Interim Review, and/or Summary from the current
performance cycle to this form and submit to DOC Personnel with the DC-154S package. This form and
appraisal documentation will be forwarded to the receiving agency.
The N. C. Department of Correction uses the North