Performance Evaluation Rebuttal Letter Form
Submit your formal rebuttal to a performance review for internal review and documentation.
Employee Name
*
First Name
Last Name
Employee Email
*
example@example.com
Job Title or Department
*
Manager/Reviewer Name
*
Review Period
*
Evaluation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Performance Rating Received
*
Please Select
Exceeds Expectations
Meets Expectations
Needs Improvement
Unsatisfactory
Other
Specific Evaluation Points Being Disputed
*
Employee’s Rebuttal Statement
*
Supporting Evidence or Examples
Desired Resolution or Follow-up Request
Submit Rebuttal
Should be Empty: