Groark, Dorothy
Town of Wappinger
Emergency Contact Information
Employee Name
Dorothy Groark
Home Address
114 Oak Park Terrace
Wappingers Falls. New York 12590
Home Phone Number (845) 297-2358
In case of an emergency, please contact Laurie Greene
(H)849-2050
Day time phone number(w) 454-1942 Cell/Pager (84')) ,)90-')?C}1
Address 5 S il ve r Lane
Poughkeepsie, New York 12603
Alternate emergency contact Stacey Groark
(W)463-3011 press 3 Ext. 1505
Day time phone number Cell/Pager
546-5471
Address 18 Anthony Drive Apt. 102
Poughkeepsie. New York 12601
Doctor Dr. Harry A. Linh.<lTlh-
Address 64 Jackson Avenue
Fishkill. New York 12,)?4
Phone Number (845) 896 6203
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SUPERViSOR
Christopher Colsey
TOWN OF W...~.FPINGER
. SUPERVISOR'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590-0324
(845) 297.2744
FAX: (845) 297-4558
VACATION REQUEST
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DEPT
DATES
SUPERVISOR
*DATE '{4D~
>i<:MUST SUM:M.IT TO DEPARTMENT HEAD TWO WEEKS PRIOR TO
REQUESTED TIME OFF.
TOWN COUNCIL
VINCENT BElliNA
Maureen McCarthy
JOSEPH P. PAOLONi
William H. Beale
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TOWN OF WAPPINGER
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P.o. Box 324
20 Middlebush Road
Wappingers Falls, NY 12590-0324
BUILDING DEPARTMENT
F1ECElVED
NO V 1 8 1994
,lltJ:TFi\%Jil'S OFFICE
TO.\II'\ C:c \Y;PPINGER
NOVEMBER 18, 1994
TO: CONSTANCE SMITH
TOWN OF WAPPINGER, SUPERVISOR
FROM: DOROTHY GROARK
RE: UNEMPLOYMENT
DEAR CONNIE,
DUE TO CIRCUMSTANCES BEYOND MY CONTROL SUCH AS: CIVIL SERVICE
TESTING, I AM FORCED TO GIVE UP MY DATA ENTRY OPERATOR POSITION WITH
THE TOWN OF WAPPINGER AS OF NOVEMBER 18, 1994. I HAVE HELD THIS POSITION
FOUR AND THREE QUARTER YEARS AND REGRET LEAVING.
IT HAS BEEN A PLEASURE WORKING FOR YOU, AND THE TOWN OF
WAPPINGER. THANK YOU VERY MUCH FOR EVERYTHING.
SINCERELY,
Q~~~
DOROTHY G OARK
TOWN OF W...A.FPINGER
SUPERViSOR
JOSEPH RUGGIERO
. SUPERVISOR'S OrFICE
20 MIDDLE BUSH ROAD
WAPPINGERS FALLS, NY 12590-0324
(845) 297-2744
FAX: (845) 297-4553
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VACA.TION REQUEST
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>i<MUST SUMMJT TO DEPARTMENT HEAD TWO WEEKS PRIOR TO
REQUESTED TIME OFF.
TOWN COUNCIL
VINCENT BETTINA
Maureen Me earthy
JOSEPH P. PAOLONi
William Beale
TOWN OF W.l~J>PINGER
SUPERVISOR
JOSEPH RUGGIERO
TOWN COUNCIL
VINCENT BETTINA
Maureen Me Garth
JOSEPH P. PAOLONI Y
William Beale
. SUPERVISOR'S Or-FICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590-0324
(845) 297-2744
FAX: (845) 297-4558
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V_*CATJON PiliQUEST
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REQUESTED TlME OFF.
STATE OF NEW YORK - DEPARTMENT OF HEALTH
Bureau of Production Systems Management
INTEROFFICE MEMORANDUM
TO:
Dorothy Groark
FROM:
Local Registrar/Clerk
SUBJECT: Vital Records Security and Confidentiality
DATE:
December 4, 2006
As a staff member of the town/city/village of Wappinger , you will be
working with highly confidential and personal information on: Certificates of birth, death
and marriage, court orders, paternity affidavits, applications, correspondence and
computer files. Vital records information and copies may only be released in
accordance with Article 41 of the Public Health Law and Articles 1, 2 and 3 of the
Domestic Relations Law. Specific instructions regarding how, when and to whom vital
records information and copies may be released are detailed in the Vital Records
procedures manual.
To promote a secure and confidential environment for the vital records, please
take note of the following:
1) Access to units of the Vital Records Section is restricted to staff of the unit and is
prohipited to all others except those having official business in the unit or who have
obtained clearance from the Director of Vital Records or Unit Supervisor. Report
unauthorized visitors to a supervisor.
2) Do not discuss identifying or personal information appearing on vital records
forms, computer files and other storage media with other staff, family or friends.
3) Unauthorized release of vital records information may result in recommended
disciplinary and/or legal action.
4) When in doubt ask your supervisor.
5) Store the vital records forms, computer files and other storage media in a secure
location with access limited to authorized staff only.
I have read this memorandum and understand the rules protecting the confidentiality of .
vital records information and that the unlawful release of vital records information may.
result' iscipli ary and/or legal action against me.
A
December 4. 2006
Date
TOWN OF Wl~J>PINGER
SUPERViSOR
JOSEPH RUGGIERO
TOWN COUNCIL
VINCENT BETTINA
JOSEPH P. PAOlON;
ROBERT L. VAlDATI
. SUPERVISOR'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590-0324
(845) 297-2744
FAX: (845) 297-4558
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SUPERVISOR
DEPT
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*MUST SUMMIT TO DEPARTMENT HEAD TWO WEEKS PRIOR TO
REQUESTED TIME OFF. '
DOG LICENSE FEES FOR THE TOWN OF WAPPINGER
· RESIDENTS OVER 65 YRS. OF AGE CAN DEDUCT $2.00 ON ALL
LICENSE FEES.
$2.50 + $2.00 = $4.50 for all SPAYED Females and NEUTERED Males
$7.50 + $2.00 = $12.50 for all Males and Females
Veterinarian Certificates MUST accompany all applications for NEUTERED
MALE DOGS AND SPAYED FEMALE DOGS that have not been previously licensed in
the Town of Wappinger, as well as a current RABIES CERTIFICATE.
Checks are made payable to: TOWN OF WAPPINGER
Application for your dog license may be made by mail as well as in person.
Mail application, check and certificate/s to:
Mr. John C. Masterson
Town Clerk/Town of Wappinger
20 Middlebush Road
Wappingers Falls, N Y 12590
DOG LICENSE FEES FOR THE TOWN OF WAPPINGER
· RESIDENTS OVER 65 YRS. OF AGE CAN DEDUCT $2.00 ON ALL
LICENSE FEES.
$2.50 + $2.00 = $4.50 for all SPAYED Females and NEUTERED Males
$7.50 + $2.00 = $12.50 for all Males and Females
Veterinarian Certificates MUST accompany all applications for NEUTERED
MALE DOGS AND SPAYED FEMALE DOGS that have not been previously licensed in
the Town of Wappinger, as well as a current RABIES CERTIFICATE.
Checks are made payable to: TOWN OF WAPPINGER
Application for your dog license may be made by mail as well as in person.
Mail application, check and certificate/s to:
Gloria J. Morse, Town Clerk
P.O. Box 324
Wappingers Falls, NY 12590
TOWN OF W...APPINGER
SUPERViSOR
JOSEPH RUGGIERO
TOWN COUNCIL
VINCENT BElliNA
JOSEPH P. PAOLONi
ROBERT L. VALDATI
. SUPERVISOR'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590-0324
(845) 297-2744
FAX: (845) 297-4558
VACATION REQUEST
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DEP ARTMENT HEAD
NAME
DEPT
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*DATE
>i<MUST SUMMIT TO DEPARTMENT HEAD TWO WEEKS PRIOR TO
REQUESTED TIME OFF.
RECE'V'-:-',
APR 2 3 2007
TOWN CLERK
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Name: DOROTHY
GROARK
3/31/07
Personal Hours Available: 14.00
Personal Hours Taken: 9.30
Personal Hours Remaining: 4.30
Sick Days Available: 72.00
Sick Days Taken: 0.00
Sick Days Remaining: 72.00
Vacation Days Available: 15.00
Vacation Days Taken: 4.00
Vacation Days Remaining: 11.00
Name: DENISE
MACIO
3/31/07
Personal Hours Available: 14.00
Personal Hours Taken: 4.30
Personal Hours Remaining: 9.30
Sick Days Available: 4.00
Sick Days Taken: 0.00
Sick Days Remaining: 4.00
Vacation Days Available: 0.00
Vacation Days Taken: 0.00
Vacation Days Remaining: 0.00
04/04/2007
Page
1
SUPERVISOR
JOSEPH RUGGIERO
TOWN OF WAPPINGER
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TOWN COUNCIL
WILLIAM H. BEALE
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOLONI
SUPERVISOR'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
(845) 297-2744
FAX; (845) 297-4558
Memo
To:
Hon. Chris Masterson, Town Clerk
From:
Gina Basile
Date:
February 6, 2007
Re:
John Rossero Complaint
Mr. John Rossero came into my office today to complain about the way he was treated by
your office. He explained that his 91 year old mother's handicap permit was going to
expire in the future, and he wanted to know in advance what he needed to bring with him
when he was going to renew it.
Mr. Rossero explained that he first spoke with Dot. He said that Dot said she did not
know and she had to ask Denise.
Denise then began to interact with Mr. Rossero. He said that she acted as if he did not
deserve to get the permit. She told him that he had to bring in his mothers ID. He
explained that she did not have a driver's license and asked what he should bring. He
said that Denise's response was, "I told you, ID". He then asked what ID would be
appropriate and she did not respond so he asked if a social security card was acceptable
and she said yes. Mr. Rossero continued to say that Denise was rude throughout the
entire process.
At that point Mr. Rossero said that someone Denise knew walked into your office, and
she walked away from him to talk to that other person.
Mr. Rossero gave me his cell phone number so he could be contacted. His number is
914-582-9294.
If you have any questions, please feel free to contact me.
w" l~
TOWN OF WAPPINGER
PERFORMANCE OBSERVATION FORM PO
Name / Title of Employee Observed Dorothy Groark
Name / Title of Department Head Issuing POF: Chris Masterson / Town Clerk
Date this POF was Issued: 2/6/2007
Performance Ratin!!: I Exceeds Exoectations 0 I Below Expectations 0'
OBSERVED BERA VIOR - State the behavior that was observed citing specifics such as date, time, task being performed.
On Februar 6th 2007 the Town Clerk was contacted b the confidential secretar to
the Supervisor, Gina Basile. Ms. Basile informed the Town Clerk that she received a
com laint about both de ut clerks from a Mr. John Rossero. The com laint was about
the interaction Mr. Rossero had with the de ut clerks while in to ask about renewin
his mothers handica ed ermit. The Town C erk called Mr. Rossero at a roximatel
1:45PM, Mr. Rossero confirmed that he had made the com laint. He stated that
[De uty Town Clerk Groark) was unable to hel answer the uestions that he had. He
wanted to find out what would be needed when he comes in to renew the current ermit
and De ut Town Clerk Groark could not he h'm. He then sad that De ut Town
Clerk Denise Macio came to the counter to help. She notified Mr. Rossero that he
- CONTINUED ON BACK OF FORM -
PERFORMANCE IMPROVEMENT PLAN - (Complete this section onlv if the Rating is Below Expectations and the
Department Head deems an improvement plan is needed) This Plan should include an identification of the performance area in which the
employee needs to develop; specific steps to facilitate this development; and the criteria that will be used to measure progress.
Employee's Signature verifying that the above POF
was discussed and issued on the date s ecified above:
Department Head Signature:
2/6/2007
2/6/2007
Date:
FILING INSTRUCTIONS - The Original POF is to be placed in the Employee's Personnel File. A Copy should be
given to the employee.
I,
- .,
TOWN OF WAPPINGER
SUPERVISOR
JOSEPH RUGGIERO
TOWN COUNCIL
WILLIAM H. BEALE
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOLONI
SUPERVISOR'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
(845) 297-2744
FAX: (845) 297-4558
Memo
To:
Hon. Chris Masterson, Town Clerk
From:
Gina Basile
Date:
February 6, 2007
Re:
John Rossero Complaint
Mr. John Rossero came into my bffice today to complain about the way he was treated by
your office. He explained that his 91 year old mother's handicap permit was going to
expire in the future, and he wanted to know in advance what he needed to bring with him
when he was going to renew it.
Mr. Rossero explained that he first spoke with Dot. He said that Dot said she did not
know and she had to ask Denise.
Denise then began to interact with Mr. Rossero. He said that she acted as ifhe did not
deserve to get the permit. She told him that he had to bring in his mothers 1D. He
. explained that she did not have a driver's license and asked what he should bring. He
said that Denise's response was, "I told you, 1D". He then asked what 1D would be
appropriate and she did not respond so he asked if a social security card was acceptable
and she said yes. Mr. Rossero continued to say that Denise was rude throughout the
entire process.
At that point Mr. Rossero said that someone Denise knew walked into your office, and
she walked away from him to talk to that other person.
Mr. Rossero gave me his cell phone number so he could be contacted. His number is
914-582-9294.
If you have any questions, please feel free to contact me.
..
TOWN OF WAPPINGER
Performance Appraisal Form
Administrative Support Staff
Employee Dorothy Groark
Evaluator Chris Masterson
Position Deouty Town Clerk #3
Date of Appraisal /z-l,z IIJ It'
, I
Period Covered:
from 01/01/2006 to 09/01/2006
Reason for Appraisal:
Probationary Period 0
Annual I:8J
Promotion 0
SECTION I: INSTRUCTIONS
· The Evaluator Should:
· Review the Performance Appraisal Rating Scale (refer to Section II) so that you are competent and
objective in completing the appraisal. Any questions should be directed to the Town Supervisor.
· Be familiar with the employee's Job Description, especially the Essential Job Functions, prior to
conducting the employee's performance appraisal.
· Provide the employee with an Employee Self Appraisal Form at least one week prior to the appraisal.
Date form given to employee 04/05/2006
· Prior to the date of the appraisal, review and rate the Performance Factors and then give an Overall
Appraisal Rating of the performance for the last performance appraisal period. The Evaluator should
submit the ratings to the Town Supervisor for review prior to meeting with the employee. After the
Town Supervisor reviews the ratings, the Evaluator should schedule the appraisal meeting.
· Prior to the date of the appraisal meeting, complete the Goals Section. The employee should provide
input in developing the goals.
· Following the appraisal meeting, the Evaluator should forward the original signed Performance
Appraisal Form to the Town Supervisor's Office to be placed in the employee's personnel file. A copy
should be given to the employee.
. The Employee Should:
· Complete the Employee Self Appraisal Form prior to the appraisal.
· The Evaluator and Employee Jointly Should:
· Review the completed Employee Self Appraisal Form at the time of the appraisal. This form is for
discussion purposes only and should not be attached to the final performance appraisal.
· Review the results of the performance appraisal at the time of the appraisal.
· Discuss the Goals Section with the employee at the time of the appraisal.
· Sign the Final Performance Appraisal. All entries and comments must be done in ink. The evaluator
should give the employee a day or two to offer any comments.
Town of Wappinger Performance Appraisal: Administrative Support Staff (4/06)
Page 1 of 5
SECTION II: PERFORMANCE APPRAISAL RATING SCALE
1 Unsatisfactory Pe~~rma.nce is consi~te.ntly below expectations. An action plan is required to address performance
defiCIencies and remain In current position.
2 Needs Development Results achieved demonstrate a need for development in one or more requirements of the position
Acceptable performance must be more consistent to be evaluated as Meets Expectations. .
3 Meets Expectations Performance .consistently meets the high expectations of the Town and satisfies job requirements.
Performance IS what you would expect from an overall competent employee.
4 Exceeds Expectations Pe.rformance consistently meets, and occasionally exceeds, the high expectations of the Town. This
rating may be used when the employee exceeded most of the critical targets and met all the others.
5 Role Model Performance consistently exceeds the high expectations of the Town. Employee's performance
would be considered a Role Model.
SECTION III: APPRAISAL OF TOWN OF WAPPINGER PERFORMANCE FACTORS
1. CUSTOMER SERVICE AND PUBLIC RELATIONS Rating _3_
Consistently provides solutions to effectively and promptly address internal and external customer needs. Projects
a positive image of the Town and Department. Interacts with the public in a prompt, helpful and courteous manner.
Comments/Examples
SEE ATTACHED
2. COMMUNICA T/ON Rating _3_
Communicates effectively both verbally and in writing. Maintains the integrity of internal information. Provides
supervisors, co-workers and the public with accurate information and in a timely manner. Informs supervisor of job-
related problems as thev occur.
Comments/Examples
SEE ATTACHED
3. PRODUCTIVITY AND INITIA T/VE Rating _3_
Handles tasks efficiently with a minimum of mistakes. Meets exceptions to routine work resourcefully. Adapts to
organizational changes or sudden shifts in priorities. Offers suggestions for improving department operations.
Maintains the volume of work and meets deadlines and goals. Does what is necessary to get the job done.
Comments/Examples
SEE ATTACHED
4. TEAMWORK Rating _3_
Accepts constructive criticism and instruction in a positive manner. Works cooperatively with others and helps
others freely when needed. Shares own knowledge and expertise with supervisors and coworkers to promote the
department's obiectives. Demonstrates credibility with supervisors and coworkers.
Comments/Examples
SEE ATTACHED
5. WORK ETHIC Rating _3_
Complies with the Town's policies and procedures including but not limited to attendance, safe work practices,
operational policies, work rules, and appearance, both personal and workspace.
Comments/Examples
SEE ATTACHED
Town of Wappinger Performance Factors: Average Rating AVERAGE
(Total Points + 5) RATING
_3.0_
Town of Wappinger Performance Appraisal: Administrative Support Staff (4/06)
Page 2 of 5
SECTION IV: APPRAISAL OF JOB-SPECIFIC PERFORMANCE FACTORS
Select 3 - 5 of the Most Important Essential Job Functions (EJF) from the Job Description
EJF #1 Rating _3_
SEE ATTACHED
EJF #2 Rating _3_
SEE ATTACHED
EJF #3 Rating _3_
SEE ATTACHED
EJF #4 Rating _3_
SEE ATTACHED
EJF #5 Rating _
Job Specific Performance Factors: Average Rating AVERAGE
(Total Points + # of EJF rated) RATING
- 3.0 -
Comments/Examples
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Town of Wappinger Performance Appraisal: Administrative Support Staff (4/06)
Page 3 of 5
SECTION V: APPRAISAL OF PROGRESS OF GOALS
Evaluate how the employee managed and/or achieved the goals established for this appraisal period.
Not Yet In Date
GOALS ESTABLISHED FROM PREVIOUS APPRAISAL PERIOD Started Progress Completed
(Give Reason)
1.
N/A
2.
N/A
SECTION VI: IDENTIFICATION OF GOALS FOR NEXT APPRAISAL PERIOD
GOALS FOR NEXT APPRAISAL PERIOD ENDING _/_/_
Note: At least one of these goals should be based on a PERSONAL SKILL OR HABIT you wish to improve over the next
year. Examples of PERSONAL SKILLS/HABITS are: time-management capabilities, organizational skills, prioritization
skills, interpersonal skills, motivation, initiative, etc.
Brief Description of Goal 1 :
SEE ATTACHED
What assistancelresources do you need to help you achieve this goal?
How can the progress of this goal be measured?
Brief Description of Goal 2:
SEE ATTACHED
What assistance/resources do you need to help you achieve this goal?
How can the progress of this goal be measured?
Town of Wappinger Performance Appraisal: Administrative Support Staff (4/06)
Page 4 of 5
-- ---- ...
H f/ S NoT \)2.,MlYl5/'Y(At(,D
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ElF #2 - Mrs. Groark handles all bookkeeping and compiles monthly reports. Mrs.
Groark does a fantastic job when all business runs smooth. However, she IS unable 0
handle, assess and adapt to, situations such as the bouncing ofa customer's check.
EFI #3 - Mrs. Groark handles half ofthe marriage licenses processed through the office.
There have been occasions when licenses were mailed to the wrong licensee and licenses
have gone out without the Town seal. Aside from those fatal errors, the remainder ofthe
mistakes is usually typographical and caught before the license is issued.
EFI #4 - Mrs. Groark handles all ofthe outgoing mail and conducts mail runs to the post
office in the Town Clerk's absence. After a replacement of equipment, there was a brief
period of trouble in adapting. Since then, Mrs. Groark has done a fine job in the conduct
of tasks related to Town mail.
Comments: Mrs. Groark does not provide backup assistance as need, such as attending
ZBA meetings and taking minutes. Therefore, that EJF should be removed from Mrs.
Groark's job description.
Goals
Mrs. Groark lists her goals as to include: broadening her skills as Deputy Town Clerk
Additional goals should include:
Better time management
She will also need to work on managing her stress level in situations that should not
warrant increased stress levels
Specific goals are: .
Familiarization with Microsoft Office SUIte
Word - become better acquainted with features such as mail merge,
saving documents, organizing saved files
Excel- Understand the difference between cells, rows, columns, and
worksheets
Understand the concept of formulas
Understand how to format cells
Access - Understand the difference between tables, forms, and queries
Learn how to sort, filter, and search records
Understand scroll bars and how to use them
Mrs. Groark will have the opportunity to learn via OJT and will also have the
benefit of using any of a large selection of textbooks that she chooses
Mrs. Groark will have the Town Clerks help as needed.
()~ a U i( r So C? ClJY1 + e t hr. c.(),..,
TOWN OF WAPPINGER
EMPLOYEE SELF-APPRAISAL FORM
(The self-appraisal is for discussion purposes and should be detached from the performance appraisal form. This form is
not to be placed in the employee's personnel file, but rather used as a tool for performance planning.)
Position:
Date:
The following questions are intended to help you prepare for your performance appraisal meeting. Your input
is a vital part of the performance appraisal process and win be discussed with you during the meeting.
1. What do you feel are your major accomplishments over the course of the. previous performance
appraisal period?
2. What additional assistance or training do you need to perform your job better? If training is requested, .
check all that apply and explain how such training would have an impact on your job performance.
Computer Supervisory Skills Customer Relations Communication
Skills
Safety Organizational Goal Development Other (please indicate)
(PESH/OSHA) Skills
3. What were the biggest obstacles you faced in the attainment of the goals established for the current
performance appraisal period?
4. would you be interested in working toward between now and the next performance
Town of Wappinger Performance Appraisal: Employee Self Appraisal Form (1/06)
1 of 1
Page
TOWN OF WAPPINGER
Performance Appraisal Form Administrative Support Staff
Employee bOQo 1l{ y 6tZ..oAJU( Position fk..Ru ""'y t"l.1lA.)/1 (" IA (2.JC 3-
Evaluator C H R( S WI A-& ~ ~.so" Date of Appraisal
Period Covered: from ~ W OLe> to J M-or. t:j' jI /0 f:'
Reason for Appraisal:
Probationary Period 0
Annual ~ Promotion 0
SECTION I: INSTRUCTIONS
· The Evaluator Should:
.
Review the Performance Appraisal Rating Scale (refer to Section II) so that you are competent and
objective in completing the appraisal. Any questions should be directed to the Town Supervisor.
.
Be familiar with the employee's Job Description, especially the Essential Job Functions, prior to
conducting the employee's performance appraisal.
..
Provide the employee with an EmPlo~elf Appraisal Form at least one week prior to the appraisal.
Date form given to employee 4 OCD . .
.
Prior to the date of the appraisal, review and rate the Performance Factors and then give an Overall
Appraisal Rating of the performance for the last performance appraisal period. The Evaluator should
submit the ratings to the Town Supervisor for review prior to meeting with the employee. After the
Town Supervisor reviews the ratings, the Evaluator should schedule the appraisal meeting.
.
Prior to the date of the appraisal meeting, complete the Goals Section. The employee should provide
input in developing the goals.
.
Following the appraisal meeting, the Evaluator should forward the original signed Performance
Appraisal Form to the Town Supervisor's Office to be placed in the employee's personnel file. A copy
should be given to the employee.
· The Employee Should:
· Complete the Employee Self Appraisal Form prior to the appraisal.
· The Evaluator and Employee Jointly Should:
· Review the completed Employee Self Appraisal Form at the time of the appraisal. This form is for
discussion purposes only and should not be attached to the final performance appraisal.
· Review the results of the performance appraisal at the time of the appraisal.
· Discuss the Goals Section with the employee at the time of the appraisal.
· Sign the Final Performance Appraisal. All entries and comments must be done in ink. The evaluator
should give the employee a day or two to offer any comments.
Town of Wappinger Performance Appraisal: Administrative Support Staff (1/06)
Page 1 of 5
SECTION II: PERFORMANCE APPRAISAL RATING SCALE
1 Unsatisfactory Performance is consistently below expectations. An action plan is required to address performance
deficiencies and remain in current position.
2 Needs Development Results achieved demonstrate a need for d~velopment in one or more requirements of the position.
Acceptable performance must be ~ore consistent to be evaluated as Meets Expectations.
3 Meets Expectations Performance consistently meets the high expectations of the Town and satisfies job requirements
Performance is what you would expect from an overall competent employee. .
4 Exceeds Expectations Performance consistently meets, and occasionally exceeds, the high expectations of the Town. This
rating may be used when the employee exceeded most of the critical targets and met all the others.
5 Role Model Performance consistently exceeds the high expectations of the Town. Employee's perfonmance
would be considered a Role Model.
SECTION III: APPRAISAL OF TOWN OF WAPPINGER PERFORMANCE FACTORS
./
1. CUSTOMER SERVICE AND PUBLIC RELA TIONS Rating -lL
Consistently provides solutions to effectively and promptly address internal and external customer needs. Projects
a positive imaqe of the Town and Department. Interacts with the public in a prompt, helpful and courteous manner.
Comments/Examples
"
2. COMMUNICA TION Rating ~
Communicates effectively both verbally and in writing. Maintains the integrity of internal information. Provides
supervisors, co-workers and the public with accurate information and in a timely manner. Informs supervisor of job-
related problems as thev occur.
Comments/Examples
-?
3. PRODUCTIVITY AND INITIA TlVE Rating ....l-
Handles tasks efficiently with a minimum of mistakes. Meets exceptions to routine work resourcefully. Adapts to
organizational changes or sudden shifts in priorities. Offers suggestions for improving department operations.
Maintains the volume of work and meets deadlines and aoals. Does what is necessary to Qet the iob done.
Comments/Examples
4. TEAMWORK Rating"&:
Accepts constructive criticism and instruction in a positive manner. Works cooperatively with others and helps
others freely when needed. Shares own knowledge and expertise with supervisors and coworkers to promote the
department's objectives. Demonstrates credibilitv with suoervisors and coworkers.
Comments/Examples
y~...,
5. WORK ETHIC Rating -.::.:::...
Complies with the Town's policies and procedures including but not limited to attendance, safe work practices,
operational policies, work rules, and appearance, both personal and worksoace.
Comments/Examples
Town of Wappinger Performance Factors: Average Rating AVERAGE
(Total Points + 5) RATING
'.^.. -j
-
:3
~
-;L
Town of Wappinger Performance Appraisal: Administrative Support Staff (1/06)
Page 2 of 5
SECTION IV: APPRAISAL OF JOB-SPECIFIC PERFORMANCE FACTORS
Select 3 - 5 of the Most Important Essential Job Functions (EJF) from the Job Description
EJF #1 Rating ....L
,
EJF #2 Rating _
-)
EJF #3 Rating _
EJF #4 RatingK
EJF #5 Rating _
Job Specific Performance Factors: Average Rating AVERAGE
(Total Points +# ofEJF rated) RATING
-L
.. , -
3
3
Comments/Examples
Town of Wappinger Performance Appraisal: Administrative Support Staff (1/06)
Page 3 of 5
SECTION V: APPRAISAL OF PROGRESS OF GOALS
Evaluate how the employee managed and/or achieved the goals established for this appraisal period.
Not Yet In Date
GOALS ESTABLISHED FROM PREVIOUS APPRAISAL PERIOD Started Progress Completed
. (Give Reason)
1.
2.
SECTION VI: IDENTIFICATION OF GOALS FOR NEXT APPRAISAL PERIOD
GOALS FOR NEXT APPRAISAL PERIOD ENDING _'-1_
Note: At least one of these goals should be based on a PERSONAL SKILL OR HABIT you wish to improve over the next
year. Examples of PERSONAL SKILLS/HABITS are: time-management capabilities, organizational skills, prioritization
skills, interpersonal ski/Is, motivation, initiative, etc.
Brief Description of Goal 1 :
What assistance/resources do you need to help you achieve this goal?
I
How can the progress of this goal be measured?
Brief Description of Goal 2:
What assistance/resources do you need to help you achieve this goal?
How can the progress of this goal be measured?
Town of Wappinger Performance Appraisal: Administrative Support Staff (1/06)
Page 4 of 5
SECTION VI: OVERALL APPRAISAL SUMMARY
l
APPRAISAL SUMMARY
RATING
Category 1 . Town of Wappinger Performance Factors
Reference Section 111- Avera e Ratin
s and Divide b 2
~S
~.3
? ~~ 7
-/ ,) .:, .;:;
Category 2 - Job-Specific Performance Factors
Reference Section IV - Avera e Ratin
( (,'
Rating Rating Rating Definition
Ram:'le
<2 Unsatisfactory Performance is consistently below expectations. An action plan is required to address
performance deficiencies and remain in current position.
2.00 - 2.75 Needs Development Results achieved demonstrate a need for development in one or more requirements of the
position. Acceptable performance must be more consistent to be evaluated as Meets
Expectations.
2.76 - 3.75 Meets Expectations Performance consistently meets the high expectations of the Town and satisfies job
requirements. Performance is what you would expect from an overall competent
employee.
3.76 - 4.50 Exceeds Expectations Performance consistently meets, and occasionally exceeds, the high expectations of the
Town. This rating may be used when the employee exceeded most of the critical targets
and met all the others.
>4.50 Role Model Performance consistently exceeds the high expectations of the Town. Employee's
performance would be considered a Role Model.
SECTION VII: SIGNATURES AND COMMENTS
EMPLOYEE COMMENTS:
EMPLOYEE ACKNOWLEDGMENT:
I certify that the contents of this appraisal were reviewed and discussed with me.
Employee Signature:
Date:
Evaluator Signature:
Date:
TOWN SUPERVISOR'S USE ONLY
Date Reviewed by Town Supervisor
Town Supervisor's Signature
Town of Wappinger Performance Appraisal: Administrative Support Staff (1/06)
Page 5 of 5
TOWN OF WAPPINGER
EMPLOYEE SELF-APPRAISAL FORM
(The self-appraisal is for discussion purposes and should be detached from the performance appraisal form. This form is
not to be placed in the employee's personnel file, but rather used as a tool for performance planning.)
.Position:
Date:
The following questions are intended to help you prepare for your performance appraisal meeting. Your input
is a vital part of the performance appraisal process and will be discussed with you during the meeting.
1. What do you feel are your major accomplishments over the course of the previous performance
appraisal period?
2. What additional assistance or training do you need to perform your job better? If training is requested,
check all that apply and explain how such training would have an impact on your job performance.
Computer Supervisory Skills Customer Relations Communication
Skills
Safety Organizational Goal Development Other (please indicate)
(PESH/OSHA) Skills
3. What were the biggest obstacles you faced in the attainment of the goals established for the current
performance appraisal period?
4. What goals would you be interested in working toward between now and the next performance
appraisal?
Town of Wappinger Performance Appraisal: Employee Self Appraisal Form (1/06)
Page 1 of 1
SEND TO: Peter M. Carucci, Director, Vital Records
P.O. Box 2602, Albany, NY 12220-2602
To the State Commissioner of Health, A Ibarry, New York
Under the authority of the provisions of Section 4122 of the Public Health Law, I do hereby appoint, subject to your
Approval of Appointment of
Subregistrar of Vital Statistics
I District No. 13Co~;13JL(.1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
approval
Dorothv Groark
as Subregistrar of Vital Statistics.
The location of registration services will be 20 Mi dd lebush Road. Wapp i nqers Fa II s.
Street Post Office
or at such other place as shall be deemed necessary.
NY 12590
(845) 297-5771
(Area Code) Phone
Zip
This appointment is necessary for the convenience of the people in this district for the following reasons:
In absence of Reaistrar and Deputv Reaistrar
John C. Masterson
Print (or) Type Registrar's Name
Approved by
Antonia C. Novello, M.D., M.P.H., Dr. P.H.
New York State Commissioner of Health
Date ~ Oeo
Date March 3. 2006
STATE OF NEW YORK
By:
(fF-~ L
Pe er M. Carucci
Director
Vital Records Section
/
) ss.:
County of Dutchess
I do solemnly swear (affirm) that I will support the Constitution of the United States, and the Constitution of the State of
New York, and that I will faithfully discharge the duties of the office of Subregistrar of Vital Statistics, according to the
best of my ability
! am not engaged in the buciness of funeral directing, embalming, or undertaking.
Signed
114 Oak Park Terrace (845) 297-2358
Home Address Wapp i ngers Fa II SArea Code) Phone
New York 12590
~rA Vtt .
Subscribed and sworn to (affirmed) before me this t:'J day of ~ ~Ct:&
MARIA GilBRIDE ~
Notary P"blir., State of New .:;:::,:' Notary Public
Reg. No. OlGI5087374 . . ';'"i
Qualified in Dutchl'sS Coy,rity _,
(ommission Expires Nov. 3, ~
DOH-2457 (4/2000)
Page 1 of 1
Chris Masterson
From: Jim Williams [jwilliams19@hvc.rr.com]
Sent: Sunday, February 26, 2006 12: 17 PM
To: cmasterson@townofwappinger.us
Subject: death records
MR. MATHEWS; I AM GLAD TO FIND THAT YOU HAVE AN E-MAIL SERVICE. I AM DOING FAMILY
. RESEARCH AND SEVERAL WEEKS AGO I STOPPED BY YOUR OFFICE TO GET A COpy OF A DEATH
RECORD. I APPROACHED YOUR OFFICE BUT NO ONE WAS AVAILABLE. AFTER SEVERAL MINUTES A
WOMAN WITH BLONDE HAIR HOLDING AN AROSAL SPRAY CAN CAME INTO THE OFFICE. I SAID THAT I
WAS DOING FAMILY RESEARCH AND SHE QUICKLY SAID" I DON'T HANDLE THAT AND THE GIRL WHO
DOES THIS OUT ILL AND WILL BE OUT FOR SEVERAL WEEKS" SHE SAID THIS WIHILE SPRAYING THE
OFFICE. STUNNED, I ASKED ABOUT MARRIAGE RECORDS. SHE SAID "OH I CAN HELP YOU WITH THAT
BUT NOT NOW, I BACKED UP." I POLITELY SAID THANK YOU VERY MUCH AND STARTED TO LEAVE,
TRYING TO CONTROL MY ANGER.
SHE CALLED TO ME AND SAID I CAN GIVE HER YOUR NUMBER AND HAVE HER CALL YOU. AGAIN I
SAID THAT'S OKAY. MY HUSBAND AND YOUR SECURITY GUARD WERE WITNESSES. THE REASON
FOR THIS NOTE IS I WORKED AND WAS TOWN CLERK IN THE TOWN OF NEWBURGH FOR 33 YEARS
AND IF I OR ANYONE IN MY OFFICE REFLECTED TO THE PUBLIC THAT THE CLERK'S OFFICE COULD
NOT BE OF ASSISTANCE, OR TAKE A FEW SECONDS TO BE HELPFUL, I KOW IF IT HAPPENED TOO
OFTEN, I WOULD NOT BE ELECTED AND THE WORKER WOULD BE INSTRUCTED TO TAKE A BETTER
APPROACH TO SERVING THE PUBLIC. WE ARE FROM NEWB URGH AND HAPPENED TO FIND A
GRAVESTONE IN THE WAPPINGERS RURAL CEMETERY WITH THE NAMES OF MY HUSBAND'S GREAT
GREAT GRANDPARENTS, IT LISTED THE DATES OF THEIR DEATHS. HIS GREAT GREAT GRANDFATHER
WAS KILLED AT THE BATTLE OF CHANCELLORSVILLE, VIRGINIA. (CIVIL WAR) WE WERE VERY
EXCITED TO FIND HIS BURIAL PLACE AND THIS EXCITEMENT WAS DRAINED BY YOUR CLERK'S
ATTITUDE. I WOLD LIKE TOPL Y FOR A COPY OF
CAROLINE RUSH'S DEATH CERTIFICATE. YOUR OFFICE WILL MOST LIKELY TAKE LESS TIME THAN THE
STATE AND I NEED AN APPLICATION FOR THIS DOCUMENT. DID NOT SEE IT ON YOUR WEB SITE. CAN
YOU HELP. HOPE THINGS HAVE IMPROVED.....
ALlSA WILLIAMS, 53 COACH LANE, NEWBURGH NEW YORK 12550. THANKS IN ADVANCE.
2/26/2006
Page 1 of 1
Chris Masterson
From: Jim Williams [jwilliams19@hvc.rr.com]
Sent: Sunday, February 26,2006 12:12 PM
To: cmasterson@townofwappinger.us
Subject: DEATH RECORDS
I RECENTLY WAS AT YOUR OFFICE TO OBTAIN A COpy OF A DEATH RECORD. WHEN I ADVISED THAT
I WAS DOING FAMILY RESEARCH, I WAS QUICKLY TOLD BY THE BLONDE HAIR WOMEN (WHO WAS
SPRAYING THE OFFICE WITH AN AROSOL SPRAY CAN) THAT THE PERSON WHO HANDLED THAT WAS
OUT ILL AND WOULD BE OUT FOR ABOUT TWO WEEKS. I ASKED ABOUT MARRIAGE RECORDS, SHE
SAID SHE COULD DO THAT BUT NOT NOW BECAUSE SHE WAS BACKED UP. (NO ONE ELSE IN THE
OFFICE NO PHONES RINGING AND WE WERE THE ONLY ONES AT THE WINDOW) AS WE (MY HUSBAND
AND I) WALKED AWAY SHE SAID I CAN GIVE HER YOUR NUMBER AND HAVE HER CALL YOU WHEN SHE
GETS BACK. I POLITELY SAID THAT'S OKAY THANK YOU AND WE LEFT (NOT HAPPY). WE ARE FROM
NEWBURGH AND JUST PRIOR TO COMING TO YOUR OFFICE WE RODE THROUGH THE WAPPINGERS
RURAL CEMETERY AND FOUND THE GRAVESTONE OF MY HUSBANDS GREAT GREAT
GRANDPARENTS.
HIS GG GRANDFATHER ROBERT RUSH WAS KILLED IN THE CIVIL WAR AT THE BATTLE OF
CHANCELLORSVILLE. WE WERE ELATED TO FINALLY FIND HIS BURIAL SITE. I WOULD LIKE TO
REQUEST A COpy OF CAROLINE RUSH'S DEATH RECORD BUT I ONLY COULD FIND THE STATE'S FORM
FOR GENEALOGICAL PURPOSES. THE STATE WILL TAKE MONTHS TO PROCESS AND I WOULD LIKE
TO GO THROUGH YOU. COULD YOU SEND ME A FORM TO MAKE APPLICATION. THANKS IN
ADVANCE. HOPE THINGS HAVE IMPROVED. ALSO YOUR SECURITY GUARD WAS PRESENT DURING
THIS EXCHANGE.
ALlSA WILLIAMS, 53 COACH LANE, NEWBURGH, NEW YORK 12550
2/26/2006
...
,..
DeDartment 1000 Town Clerk
Position 1004 Deputy Town Clerk #3
TOWN OF WAPPINGER
JOB DESCRIPTION
JOB TITLE:
CIVIL SERVICE CLASSIFICATION:
EMPLOYMENT STATUS:
PREPARED BY:
Deputy Town Clerk #3
Exempt
Full-Time
AMTEK, 8/99, revised 8/05
JOB SUMMARY:
Perform secretarial, clerical, phone and counter functions associated with the operation of the
Town Clerk's Office. Perform duties ofthe Town Clerk in the absence ofthe Town Clerk.
ESSENTIAL JOB FUNCTIONS:
100% Provide assistance to customers at counter and on the telephone; respond to questions,
comments, complaints.
Marriages- Type and prepare licenses. Type marriage certificates and mail, record
marriages in Marriage Record Book. Index marriage licenses and forward to State.
Dog Licenses- Issue original and renewals. Type cards for records in office. Record
renewals on monthly renewal listings. File renewals and original licenses. Collect monies
for dog licensing. Prepare licenses and forward license records to State weekly.
Refuse Tickets- Sell tickets over the counter. Fill requests by mail. Order supplies of refuse
tickets to be sold.
Recycling Permits- Issue paperwork and permit. File typed cards. Provide information
about refuse and recycling program.
Handicapped Parking Permits- Distribute applications and fill requests. File applications.
Perform data entry of pertinent information into the BAS computer.
Conservation Licenses- Issue hunting, trapping, and fishing licenses. Collect monies from
each. Perform data entry of pertinent information into the DECALS computer.
Bond Book- Keep bond book up to date on all entries.
Petty Cash- Disburse monies to other departments from petty cash. Prepare vouchers for
petty cash reimbursements. Balance cash and maintain upkeep.
Position 1004 Deputy Town Clerk #3
Page 1 of3
.
~
ESSENTIAL JOB FUNCTIONS (continued):
Telephones- Answer phones, act in the capacity of receptionist and direct various calls to
other departments.
Correspondence- Handle general requests by mail.
Banking- In the absence ofthe Town Clerk, make bank deposits.
Register- Collect all daily money from counter work and other departments. In the absence
of the Town Clerk, total out cash register at end of day.
Mail- Stamp all outgoing mail for the Town each day and take outgoing mail to the Post
Office. Send out Town Board's mail twice a week. Handle any breakdown of mailing
machine. In the absence of the Town Clerk, pick up incoming mail.
Copy Work- Make copies of correspondence, licenses, maps, etc.
Filing- File all dog related materials, file marriage records, file death records, file
handicapped parking records.
Federal Express- Type mailers and prepare parcel for pickup. Call Federal Express and
arrange pickup.
Animal Hospital- Handle money from Animal Hospital for fees.
Vouchers- Prepare vouchers for postage meter and miscellaneous purchases.
Bids- Sale of Bid Specification. Collect monies for bids, disperse to builders. Collect bids
when due.
Bookkeeping Duties- (In the absence of the Bookkeeper) Count and balance previous day's
receipts. Set up next day's cash money. Check and balance money and prepare bank
deposit. Balance monthly bank account.
Genealogy- Fulfill request for information regarding births, deaths, and marriages.
Complete searches through old records and type and mail requests.
Copier- Make copies and assist with problems with copier. Troubleshoot problems and
clear paper path problems. Call for maintenance on copier when needed.
Banking- In the absence of Town Clerk, make bank deposits.
Provide backup assistance as needed, such as attending ZBA meetings and taking minutes.
Position 1004 Deputy Town Clerk #3
Page 2 of 3
,..
SUPERVISORY RESPONSIBILITIES:
The Deputy Town Clerk #3 does not have any supervisory responsibilities.
PHYSICAL ACTIVITIES AND REQUIREMENTS:
Ability to stoop, kneel, crouch, reach, sit, stand, use fingers, grasp, talk, and perform repetitive
motions. Ability to exert up to 10 pounds of force occasionally and/or a negligible amount of force
frequently or constantly to lift, carry, push, pull or otherwise move objects.
MINIMUM QUALIFICATIONS:
(Adopted by the Dutchess County Personnel Officer)
High school graduation or possession of a high school equivalency diploma.
EMPLOYER'S DISCLAIMER:
? All requirements are subject to possible modification to reasonably accommodate individuals
with disabilities.
? This job description in no way states or implies that these are the only duties to be performed by
the employee holding this position. Employees must follow any other job-related instructions
and perform any other job-related duties as required.
? This job description is intended for the internal use by the Town of Wappinger and does not
replace the job specification that has been adopted by the Dutchess County Personnel Officer.
? This job description does not create a contract of employment, express or implied.
Position 1004 Deputy Town Clerk #3
Page 3 of3
....1 .. DATE
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J.,
A.M.
TIME_P.M.
I 0 TELEPHONED
o RETURNED YOUR CALL
o PLEASE CALL
o WILL CALL AGAIN
o CAME TO SEE YOU
o WANTS TO SEE YOU
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....1 FOR ~\ .Y 5 ri-; A-
....1
<:
U PHONEI
MOBILE
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TIME P.M.
FAX
o TELEPHONED
o RETURNED YOUR CALL
o PLEASE CALL
o WILL CALL AGAIN
o CAME TO SEE YOU
a 0 WANTS TO SEE YOU
1154
TOWN OF WAPPINGER
Performance Appraisal Form
Administrative Support Staff
Employee Dorothv Groark
Position Deputv Town Clerk #3
Evaluator Chris Masterson
Date of Appraisal 12-20-07
Period Covered:
from 09/01/2006 to 12/20/2007
Reason for Appraisal:
Probationary Period 0
Annual [8J
Promotion 0
SECTION I: INSTRUCTIONS
· The Evaluator Should:
· Review the Performance Appraisal Rating Scale (refer to Section II) so that you are competent and
objective in completing the appraisal. Any questions should be directed to the Town Supervisor.
· Be familiar with the employee's Job Description, especially the Essential Job Functions, prior to
conducting the employee's performance appraisal.
· Provide the employee with an Employee Self Appraisal Form at least one week prior to the appraisal.
Date form given to employee 09/10/2007
· Prior to the date of the annraisal. rAviAW ::mrl r:::lt~ th~ PArfnr....."'....,.... c............... ~~,.,I ~I-._~ _:.._ __ .....u___..
SECTION II: PERFORMANCE APPRAISAL RATING SCALE
1 Unsatisfactory Performance is consistently below expectations. An action plan is required to address performance
deficiencies and remain in current position.
2 Needs Development Results achieved demonstrate a need for development in one or more requirements of the position.
Acceptable performance must be more consistent to be evaluated as Meets Expectations.
3 Meets Expectations Performance consistently meets the high expectations of the Town and satisfies job requirements.
Performance is what you would expect from an overall competent employee.
4 Exceeds Expectations Performance consistently meets, and occasionally exceeds, the high expectations of the Town. This
rating may be used when the employee exceeded most of the critical targets and met all the others.
5 Role Model Performance consistently exceeds the high expectations of the Town. Employee's performance
would be considered a Role Model.
SECTION III: APPRAISAL OF TOWN OF WAPPINGER PERFORMANCE FACTORS
1. CUSTOMER SERVICE AND PUBLIC RELATIONS Rating _3_
Consistently provides solutions to effectively and promptly address internal and external customer needs. Projects
a positive imaqe of the Town and Department. Interacts with the public in a prompt, helpful and courteous manner.
Comments/Examples
SEE ATTACHED
2. COMMUNICA TION Rating _2_
Communicates effectively both verbally and in writing. Maintains the integrity of internal information. Provides
supervisors, co-workers and the public with accurate information and in a timely manner. Informs supervisor of job-
related problems as they occur.
Comments/Examples
SEE ATTACHED
3. PRODUCTIVITY AND INITIA TIVE Rating _2_
Handles tasks efficiently with a minimum of mistakes. Meets exceptions to routine work resourcefully. Adapts to
organizational changes or sudden shifts in priorities. Offers suggestions for improving department operations.
Maintains the volume of work and meets deadlines and !:Ioals. Does what is necessary to !:let the job done.
Comments/Examples
SEE ATTACHED
4. TEAMWORK Rating _3_
Accepts constructive criticism and instruction in a positive manner. Works cooperatively with others and helps
others freely when needed. Shares own knowledge and expertise with supervisors and coworkers to promote the
department's objectives. Demonstrates credibility with supervisors and coworkers.
Comments/Examples
SEE ATTACHED
5. WORK ETHIC Rating _3_
Complies with the Town's policies and procedures including but not limited to attendance, safe work practices,
operational policies, work rules, and appearance, both personal and workspace.
Comments/Examples
SEE ATTACHED
Town of Wappinger Performance Factors: Average Rating AVERAGE
(Total Points + 5) RATING
_2.6_
Town of Wappinger Performance Appraisal: Administrative Support Staff (4/06)
Page 2 of 5
SECTION IV: APPRAISAL OF JOB-SPECIFIC PERFORMANCE FACTORS
Select 3 - 5 of the Most Important Essential Job Functions (EJF) from the Job Description
EJF #1 Rating _2_
SEE ATTACHED
EJF #2 Rating _2_
SEE ATTACHED
EJF #3 Rating _2_
SEE ATTACHED
EJF #4 Rating _2_
SEE ATTACHED
EJF #5 Rating _2_
Job Specific Performance Factors: Average Rating AVERAGE
(Total Points... # of EJF rated) RATING
_2.0 -
Comments/Examples
Town of Wappinger Performance Appraisal: Administrative Support Staff (4/06)
Page 3 of 5
SECTION V: APPRAISAL OF PROGRESS OF GOALS
Evaluate how the employee managed and/or achieved the goals established for this appraisal period.
Not Yet In Date
GOALS ESTABLISHED FROM PREVIOUS APPRAISAL PERIOD Started Progress Completed
(Give Reason)
1. Broaden skills as Deputy Town Clerk. Time
management. Improve skills with Microsoft Office Suite
2.
N/A
SECTION VI: IDENTIFICATION OF GOALS FOR NEXT APPRAISAL PERIOD
GOALS FOR NEXT APPRAISAL PERIOD ENDING _,_,_
Note: At least one of these goals should be based on a PERSONAL SKILL OR HABIT you wish to improve over the next
year. Examples of PERSONAL SKILLS/HABITS are: time-management capabilities, organizational skills, prioritization
skills, interpersonal skills, motivation, initiative, etc.
Brief Description of Goal 1 :
SEE ATTACHED
What assistance/resources do you need to help you achieve this goal?
How can the progress of this goal be measured?
Brief Description of Goal 2:
NIA
What assistance/resources do you need to help you achieve this goal?
How can the progress of this goal be measured?
Town of Wappinger Performance Appraisal: Administrative Support Staff (4/06)
Page 4 of 5
SECTION VII: OVERALL APPRAISAL SUMMARY
APPRAISAL SUMMARY
RATING
2.6
Category 1 . Town of Wappinger Performance Factors
Reference Section '" - Avera e Ratin
Category 2 . Job-Specific Performance Factors
Reference Section IV - Avera e Ratin
2.0
2.3
2
Needs Development
Rating Rating Rating Definition
Ranae
<2 Unsatisfactory Performance is consistently below expectations. An action plan is required to address
performance deficiencies and remain in current position.
2.00 - 2.75 Needs Development Results achieved demonstrate a need for development in one or more requirements of the
position. Acceptable performance must be more consistent to be evaluated as Meets
Expectations.
2.76 - 3.75 Meets Expectations Performance consistently meets the high expectations of the Town and satisfies job
requirements. Performance is what you would expect from an overall competent
employee.
3.76 - 4.50 Exceeds Expectations Performance consistently meets, and occasionally exceeds, the high expectations of the
Town. This rating may be used when the employee exceeded most of the critical targets
and met all the others.
>4.50 Role Model Performance consistently exceeds the high expectations of the Town. Employee's
performance would be considered a Role Model.
SECTION VIIJ: SIGNATURES AND COMMENTS
EMPLOYEE COMMENTS:
EMPLOYEE ACKNOWLEDGMENT:
I certify that the contents of this appraisal were reviewed and discussed with me.
Employee Signature:
Date:
Evaluator Signature:
Date:
TOWN SUPERVISOR'S USE ONLY
Date Reviewed by Town Supervisor
Town Supervisor's Signature
Town of Wappinger Performance Appraisal: Administrative Support Staff (4/06)
Page 5 of 5
TOWN OF WAPPINGER
EMPLOYEE SELF-APPRAISAL FORM
(The self-appraisal is for discussion purposes and should be detached from the performance appraisal form. This form is
not to be placed in the employee's personnel file, but rather used as a tool for performance planning.)
Position:
Date:
The following questions are intended to help you prepare for your performance appraisal meeting. Your input
is a vital part of the performance appraisal process and will be discussed with you during the meeting.
1. What do you feel are your major accomplishments over the course of the previous performance
appraisal period?
2. What additional assistance or training do you need to perform your job better? If training is requested,
check all that apply and explain how such training would have an impact on your job performance.
Computer Supervisory Skills Customer Relations Communication
Skills
Safety Organizational Goal Development Other (please indicate)
(PESH/OSHA) Skills
3. What were the biggest obstacles you faced in the attainment of the goals established for the current
performance appraisal period?
4. What goals would you be interested in working toward between now and the next performance
appraisal?
Town of Wappinger Performance Appraisal: Employee Self Appraisal Form (4/06)
1 of 1
Page
Performance Factors
1)
- Does not understand the basic functions of using a computer.
- Has problems with saving files over pre-existing files.
- Has problems saving files to specific locations.
- Is not familiar with basic essential software applications such as Word, Excel
and Access.
- Was instructed to become familiar with the Microsoft Office Suite in the last
evaluation and has not done so.
2)
- Has difficulty remembering details about the performance of Deputy Town
Clerk duties such as:
Recycle center
Marriage licenses - enters wrong information, sends out certificates to
wrong addresses, fails to send out certificates, has told applicants that they
don't need Birth Certificates
Conservation - provides hunters with incorrect information
- Is unfamiliar with the basic operations of Town Government, and the day to day
business being conducted, which makes understanding the filing system difficult.
3)
- Has been tasked with certain jobs such as drafting a letter, creating a calendar
and updating rosters that take unreasonable amounts of time to complete.
4)
- Is unfamiliar with key Town associates, Employees, Professionals, what they do
and how to contact them. (Ex. Stolman)
5)
- Consistently has an error report from Ag & Mkts for dog uploads.
Goals
Mrs. Groark comes to work every day with the proper mind-set and performs her duties
in a pleasant manner. She is polite to residents and coworkers. However, the increased
pace, advances in technology and policy changes are challenges.
At this point, Mrs. Groark is still helpful and pleasant to have working in the Town
Clerk's Office.
Specific Goals are not being specified for the upcoming period as no goals were achieved
in the previous period.
Mrs. Groark's main responsibilities in the upcoming period will be assisting Deputy
Town Clerk #1. Her focus will be on providing service to residents at the window and
performing typical day to day errands such as bank deposits.
(The self-appraisal is for discussion purposes and should be detached from the performance appraisal form. This form is
not to be placed in the employee's personnel file, but rather used as a tool for performance planning.)
TOWN OF WAPPINGER
EMPLOYEE SELF-APPRAISAL FORM
Position:
Date:
The following questions are intended to help you prepare for your performance appraisal meeting. Your input
is a vital part of the performance appraisal process and will be discussed with you during the meeting.
1. What do you feel are your major accomplishments over the course of the previous performance
appraisal period?
2. What additional assistance or training do you need to perform your job better? If training is requested,
check all that apply and explain how such training would have an impact on your job performance.
Computer Supervisory Skills Customer Relations Communication
Skills
Safety Organizational Goal Development Other (please indicate)
(PESH/OSHA) Skills ,/
3. What were the biggest obstacles you faced in the attainment of the goals established for the current
performance appraisal period?
4. What goals would you be interested in working toward between now and the next performance
appraisal?
Town of Wappinger Performance Appraisal: Employee Self Appraisal Form (1/06)
1 of 1
Page
'. .
SECTION VII: OVERALL APPRAISAL SUMMARY
APPRAISAL SUMMARY
Category 1 - Town of Wappinger Performance Factors
Reference Section III - Avera e Ratin
RATING
3.0
Category 2 - Job-Specific Performance Factors
Reference Section IV - Avera e Ratin
3.0
3.0
2
Meets Expectations
'2
) . ()
Rating Rating Rating Definition
Range
<2 Unsatisfactory Performance is consistently below expectations. An action plan is required to address
performance deficiencies and remain in current position.
2.00 - 2.75 Needs Development Results achieved demonstrate a need for development in one or more requirements of the
position. Acceptable performance must be more consistent to be evaluated as Meets
Expectations.
2.76 - 3.75 Meets Expectations Performance consistently meets the high expectations of the Town and satisfies job
requirements. Performance is what you would expect from an overall competent
employee.
3.76 - 4.50 Exceeds Expectations Performance consistently meets, and occasionally exceeds, the high expectations of the
Town. This rating may be used when the employee exceeded most of the critical targets
and met all the others.
>4.50 Role Model Performance consistently exceeds the high expectations of the Town. Employee's
performance would be considered a Role Model.
SECTION VIII: SIGNATURES AND COMMENTS
EMPLOYEE COMMENTS:
* bO~tJl roGlh.J'1f,.t':> Mvo{ /95 o"fl1efl ~Jt1Pl.Oye(~
EMPLOYEE ACKNOWLEDGMENT:
I certify that the contents of t
Employee Signature:
Evaluator Signature:
Date:
ll~ /l.tJ~
I 2/, 'z.,J tJfn
, ,
Date:
TOWN SUPERVISOR'S USE ONLY
Date Reviewed by Town Supervisor
Town Supervisor's Signature
Town of Wappinger Performance Appraisal: Administrative Support Staff (4/06)
Page 5 of 5
Performance Factors
1)
.
Mrs. Groark is typically very cordial with customers and residents
phone calls will be answered and customers greeted almost always in a
satisfactory amount of time
Mrs. Groark gets flustered when dealing with hostile or disgruntled customers
.
.
2)
· very comfortable on the phone dealing with residents, vendors & state
agencies that the Town deals with
· messages are usually delivered in a timely manner and contain sufficient
information
· penmanship and letter writing are weak points
3)
· Has compiled a very significant amount of data into access databases
· Mistakes are frequent but usually minor grammatical errors or omissions.
· Deadlines, such as forwarding documents to County and State authorities are
almost always met
· Has difficulty adapting to changes in policy and tremendous difficulty
adapting to changes involving technology
· Occasionally gets caught up in non-work related discussions which have a
negative effect on productivity
4)
. Very receptive to instruction
· Interacts well with coworkers and is comfortable asking for help when needed
· Has been unwilling to take on additional duties relating to the retirement of
Town Clerk #2
5)
. Is always presentable and maintains a safe work area
. Workspace is neat and organized, making it easy for coworkers to navigate
her files in her absence
. Has taken an increased amount of vacation and personal time recently
EJF
ElF #1 - Mrs. Groark handles the majority of dog license transactions. While all of the
errors in entering transaction information into the computer are not Mrs. Groark's fault,
they are having an effect on the reports that Mrs. Groark must submit. New changes to
the workflow concerning dog licensing require electronic submission of reports and
corrections to those reports when error messages are returned. Both tasks are proving to
be overly challenging to Mrs. Groark.
ElF #2 - Mrs. Groark handles all bookkeeping and compiles monthly reports. Mrs.
Groark does a fantastic job when all business runs smooth. However, she has not
,.....100:;_ ..:0.
bAA Pr
Performance Factors
1)
.
Mrs. Groark is typically very cordial with customers and residents
phone calls will be answered and customers greeted almost always in a
satisfactory amount of time
Mrs. Groark gets flustered when dealing with hostile or disgruntled customers
.
.
2)
· very comfortable on the phone dealing with residents, vendors & state
agencies that the Town deals with
· messages are usually delivered in a timely manner and contain sufficient
information
· penmanship and letter writing are weak points
3)
· Has compiled a very significant amount of data into access databases
· Mistakes are frequent but usually minor grammatical errors or omissions.
· Deadlines, such as forwarding documents to County and State authorities are
almost always met
· Has difficulty adapting to changes in policy and tremendous difficulty
adapting to changes involving technology
. Occasionally gets caught up in non-work related discussions which have a
negative effect on productivity
4)
. Very receptive to instruction
Interacts well with coworkers and is comfortable asking for help when needed
5)
. Is always presentable and maintains a safe work area
. Workspace is neat and organized, making it easy for coworkers to navigate
her files in e absence
o vacation and
as een unwifling to take on additional duties relating to the retirement of
Town Clerk #2
EJF
EJF #1 - Mrs. Groark handles the majority of dog license transactions. While all of the
errors in entering transaction information into the computer are not Mrs. Groark's fault,
they are having an effect on the reports that Mrs. Groark must submit. New changes to
the workflow concerning dog licensing require electronic submission of reports and
corrections to those reports when error messages are returned. Both tasks are proving to
be overly challenging to Mrs. Groark.