ML13083A096

NRC Form 356 - U.S. Nuclear Regulatory Commission Senior Executive Service (Ses) Candidate Development Program (Cdp) Management Evaluation Form

ML13083A096
Person / Time
Issue date:	10/31/2012
From:	NRC/OCIO/GEMSD/IMSB
To:
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Download: ML13083A096 (2)

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PRIVACY ACT STATEMENT NRC FORM 356 U. S. Nuclear Regulatory Commission Senior Executive Service (SES) Candidate Development Program (CDP)

MANAGEMENT EVALUATION FORM Pursuant to 5 U.S.C. 552a(e)(3), enacted into law by Section 3 of the Privacy Act of 1974 (Public Law 93-579),

the following statement is furnished to individuals who supply information to the U.S. Nuclear Regulatory Commission (NRC) on NRC Form 356. This information is maintained in a system of records designated as NRC-19 and described at 77 Federal Register 67217 (November 8, 2012), or the most recent Federal Register publication of the NRC's Republication of Systems of Records Notices which is located in the Agencywide Documents Access and Management System (ADAMS).

1. AUTHORITY: 5 U.S.C. 3396; 5 U.S.C. 4103; Executive Order (E.O.) 9397, as amended by E.O. 13478; E.O. 11348, as amended by E.O. 12107; 5 CFR Parts 410 and 412.

2. PRINCIPAL PURPOSE(S): To apply for the NRC Senior Executive Service (SES) Candidate Development Program.

3. ROUTINE USE(S): In addition to the disclosures permitted under subsection (b) of the Privacy Act, information may be extracted from the records and made available to Office of Personnel Management; other Federal, State, and local Government agencies; and educational institutions and training facilities for purposes of enrollment and verification of employee attendance and performance. Information may also be disclosed to a Congressional office to respond to their inquiry made at your request, to NRC-paid experts, consultants, and others under contract with the NRC, on a need-to-know basis, or to appropriate persons and entities for purposes of response and remedial efforts in the event of a suspected or confirmed breach of data from this system of records.

4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMATION: Disclosure is voluntary, however, failure to provide the requested information may prevent your being considered for the SES Candidate Development Program.

5. SYSTEM MANAGER AND ADDRESS: Associate Director for Training and Development, Office of Human Resources, U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001.

NRC FORM 356 U.S. NUCLEAR REGULATORY COMMISSION (10-2012)

NRC MD10.135 U. S. Nuclear Regulatory Commission Senior Executive Service (SES) Candidate Development Program (CDP)

MANAGEMENT EVALUATION FORM NAME OF APPLICANT NAME OF APPLICANT: (Last, First and M.I.)

INSTRUCTIONS FOR SUPERVISORS: Please provide input on the above-named applicant's demonstrated competence or potential for development in the five SES Executive Core Qualifications and NRC's SES Candidate Development Program. The information you furnish will be an important element in determining the degree to which the applicant has the executive experience or potential necessary to be successful in the Program.

BASIS FOR LEVEL OF SECTION I - MANAGEMENT ASSESSMENT OF DEMONSTRATED PERFORMANCE APPRAISAL EXPERIENCE AND/OR POTENTIAL (See Scale Below)

Performance Level Scale:

EXTERNAL ACTIVITIES FORMAL TRAINING Assign Level 3 to indicate performance would exceed what is expected of a competent SES Manager.

Assign Level 2 to indicate performance would be what is expected of a fully competent SES Manager.

3 2 1 0 ON-THE-JOB POTENTIAL Assign Level 1 to indicate performance would be below what is expected of a competent SES Manager.

Assign Level 0 to indicate you have had no opportunity to observe your employee's performance in that area.

EXECUTIVE CORE QUALIFICATIONS LEADING CHANGE: The ability to bring about strategic change, both within and outside the organization, to meet organizational goals. Inherent to this ECQ is the ability to establish an organizational vision and to implement it in a continuously changing environment. Competencies: Creativity and Innovation, External Awareness, Flexibility, Resilience, Strategic Thinking, Vision LEADING PEOPLE: The ability to lead people toward meeting the organization's vision, mission and goals.

Inherent to this ECQ is the ability to provide an inclusive workplace that fosters the development of others, facilitates cooperation and teamwork, and supports constructive resolution of conflicts.

Competencies: Conflict Management, Leveraging Diversity, Developing Others, Team Building RESULTS DRIVEN: The ability to meet organizational goals and customer expectations. Inherent to this ECQ is the ability to make decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks. Competencies: Accountability, Customer Service, Decisiveness, Entrepreneurship, Problem-Solving, Technical Credibility BUSINESS ACUMEN: The ability to manage human, financial, and information resources strategically.

Competencies: Financial Management, Human Capital Management, Technology Management BUILDING COALITIONS: The ability to build coalitions internally and with other Federal agencies, State and local governments, non-profit and private sector organizations, foreign governments, or international organizations to achieve common goals. Competencies: Partnering, Politcal Savvy, Influencing/Negotiating BRIEFLY DESCRIBE THE APPLICANT'S OVERALL POTENTIAL FOR SUCCESSFUL PERFORMANCE IN THE SES CANDIDATE DEVELOPMENT PROGRAM AND FUTURE SES POSITIONS.

SECTION II - MANAGEMENT EVALUATION I highly recommend this individual for selection into the SES Candidate Development Program.

I recommend this individual for selection into the SES Candidate Development Program.

I do not recommend this individual for selection into the SES Candidate Development Program at this time.

OFFICE DIRECTOR/REGIONAL ADMINISTRATOR RELATIONSHIP TO APPLICANT (Please Check one):

OTHER (SPECIFY)

TYPED NAME & TITLE SIGNATURE DATE NRC FORM 356 (10-2012)