Dear [human resourceofficer or supervisor’s boss],
I am writing to file a formal complaint with regard to an evaluation I received from [Name of evaluator] on [data received]. I believe that the evaluation was unfairly conducted and does not accurately reflect my work. I specifically found the inaccuracies to be present at the [indicate the areas/sections] of the evaluation form. In my opinion, the evaluator did not do a good job in reviewing my records when [he/she] wrote it.
I would like to request for a review of my evaluation and consider the actual work I do. I believe that you fill find the results to be quite different.
Thank you for lending me your extra time to address this concern.