December 20, 2016 Dear Applicant Thank you for your interest in employment with the City of Champlin. The position you are applying for requires you to fill out and return the following information: City of Champlin Application for Employment (Signed) Education, Training, Skills & Knowledge Self Assessment Veteran’s Preference Points Application (Indicated and signed) This employee will work at the Ice Forum from approximately mid-September through mid-March with a 2017 hourly salary range of $21.72 - $31.34 DOQ, with typical hours in the evening during the week and day and evening hours on the weekend. During the time from the end of March through the beginning of September, the employee will work in our Public Works Department with an hourly salary range of $22.37 – $32.29 DOQ and the typical hours worked will be weekday, daytime. Incomplete information will cause the City to reject your application and you will not be considered for the position for which you are applying. The City will not accept applications via email or fax. All applications must be received by the closing date and time or be postmarked by the closing date. You will be contacted by phone or mail concerning the status of your application once we have had an opportunity to evaluate the applicant pool. More information and an application can be found on our web site at www.ci.champlin.mn.us. Should you have any questions, please feel free to contact the Public Works front desk at (763) 421-2820 or e-mail me at CLehn@ci.champlin.mn.us Sincerely, Charles Lehn Parks & Facilities Manager City of Champlin Tentative Hiring Schedule Date Description of Event December 20, 2016 Post Position January 6, 2017 Position Closes at 4:30 p.m. January 11, 2017 January 12-13, 2017 January 17, 2017

First Round Interviews Second Round Interviews Tentative Offer Issued

January 23, 2017 Council Appointment/Approval February 6, 2017 Person Begins Position

CITY OF CHAMPLIN APPLICATION PROCEDURE FOR

PUBLIC WORKS SERVICE WORKER-ICE FORUM

2017 Salary Range:

$ 21.72 – 32.29 / Hour

Application Procedure: A City employment application must be completed, signed and submitted. Resumes will not be accepted in lieu of this requirement. Call (763) 421-2820 for application materials. Application materials can also be downloaded from the City’s web site at: ci.champlin.mn.us The City of Champlin does not accept faxed copies of applications.

Additional Materials Required: Education, Training, skills and knowledge self assessment, Copies of Certifications, and veterans preference points must be included to be considered.

Examination: Training and experience rate, oral interview, other testing as appropriate.

Apply To: Submit completed application and supplement to: City of Champlin Parks and Public Works Department 11955 Champlin Drive Champlin MN 55316

Closing Date: Must be received by 4:30pm; Friday, January 6, 2017

Please carefully review the attached job description. Keep in mind that only those applicants who meet all of the minimum qualifications will be considered for the position. Be sure to complete the application to clearly demonstrate how you meet those qualifications. Only hand delivered or mailed to the address noted on the original applications will be considered. Applications will not be reviewed until after the closing date. You will be notified as quickly as possible regarding the status of your individual applications. The City of Champlin does not discriminate on the basis of race, age, color, religion, national origin, sex, marital status, sexual preference, disability or status with regard to public assistance, or any other basis protected by law, in the admission or access to, or treatment or employment in, its programs, activities or services. To obtain this information in alternative forms such as Braille, large print, audiotape, or qualified readers, please contact the City of Champlin at (763) 421-8100.

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Posted: December 20, 2016

CITY OF CHAMPLIN EMPLOYMENT INFORMATION

The City’s Benefits Program

Includes the Following: 10 days annual vacation 12 paid holidays annually Paid sick leave Paid employee health, dental,

and life insurance Retirement Program Deferred Compensation Long Term Disability Flexible Spending Program Educational\Training

Opportunities Credit Union Employee Assistance Program Fitness Room\Equipment Other Optional Benefits Union Membership

Equal Employment Opportunity:

The City of Champlin does not discriminate on the basis of race, age, color, religion, national origin, sex, marital status, sexual preference, disability or status with regard to public assistance, or any other basis protected by law, in the admission or access to, or treatment or employment in, its programs, activities or services. To obtain this information in alternative forms such as Braille, large print, audiotape, or qualified readers, please contact the City of Champlin at (763) 421-8100.

How to Apply:

Completed City of Champlin Application for Employment

Completed Education, Training, Skills & Knowledge Self Assessment

Completed Veteran’s Preference Points Application

Background Investigation:

Final applicant will be subject to a background investigation prior to a job offer.

Medical Examination:

The City-designated physician, through medical examinations, determines the fitness of individuals selected for employment for certain positions.

Drug and Alcohol Testing:

As a means of protecting the public’s welfare and employee’s well being, the City requires drug and alcohol testing.

Probation: Each employee must satisfactorily serve a minimum 6-month probationary period.

Employment Eligibility Verification:

The City of Champlin will require documentation upon hire, of the legal right to work in the United States as required by the Immigration Reform and Control Act.

Information contained herein is subject to change and does not constitute an expressed or implied contract. Any provision contained in this bulletin may be modified or revoked without notice.

Working Hours Public Service Worker

Public Service Worker - Ice Forum Approximately MID-SEPTEMBER – MID-MARCH (ICE FORUM) Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Ice Forum

OFF

OFF

3:00 pm – 11:00 pm

3:00 pm – 11:00 pm

3:00 pm – 11:00 pm

3:00 pm – 11:00 pm

3:00 pm – 11:00 pm

Hours to vary depending on ice sales Position is subject to occasional overtime END OF MARCH – BEGINNING OF SEPTEMBER (PUBLIC WORKS) Monday Tuesday Wednesday Thursday Friday Saturday Sunday

P. Works 7:00 am -2:30 pm

7:00 am -2:30 pm

7:00 am -2:30 pm

7:00 am -2:30 pm

7:00 am -2:30 pm

OFF

OFF

Position is subject to occasional overtime

CITY OF CHAMPLIN JOB DESCRIPTION

Date: August 2015 POSITION CLASSIFICATION: Public Service Worker - Ice Forum DEPARTMENT: Parks and Public Works ACCOUNTABLE TO: Ice Forum Manager POSITION STATUS: Regular Full-Time (Non-Exempt; Union) JOB SUMMARY To provide custodial and basic maintenance services to the Ice Forum at Champlin necessary to keep building clean and safe. DUTIES & RESPONSIBILITIES 1. Provides custodial services necessary to keep the building clean, safe, and in good

functioning order, including cleaning showers, restrooms, floors and carpets, bleacher area, glass, removing trash and snow removal.

2. Directs work of building and part-time staff during scheduled shift. 3. Responsible for daily room set up in community rooms and locker room areas. 4. Make daily checks on ice plant as well as heating and cooling systems. 5. Ability to drive ice resurfacer and operate ice edger in order to maintain a quality

sheet of ice. 6. Assists in preventive maintenance program for all building systems and equipment. 7. Keeps an inventory of the necessary cleaning supplies and reorder when necessary. 8. Assist the Ice Forum Maintenance Supervisor with part-time staff. 9. Ability to sharpen skates. 10. Perform other duties as assigned. KNOWLEDGE, SKILLS, & ABILITIES Ability to follow standard safety practices and procedures commonly associated with vehicle maintenance and repair

Ability to keep routine records. Ability to communicate effectively. Ability to establish and maintain effective working relationships with employees, other departments and vendors. Respond willingly to varied work assignments. Respond willingly to flexible working hours to facilitate meeting desired conditions of City equipment. Ability to obtain any licenses required by law or the City to perform work assignment. Ability to operate an ice resurfacer and skate sharpening equipment in a satisfactory manner. Ability to maintain a positive working relationship with the other staff, including the Recreation and Arena Manager and Ice Forum Maintenance Supervisor. Ability to understand and effectively carry out oral and written assignments. Ability to operate ice maintenance equipment. Knowledge of material, methods, products and techniques used to successfully maintain City equipment. Knowledge of occupational safety precautions necessary to conduct assigned activities safely. QUALIFICATIONS High School diploma or G.E.D. Position requires a valid "Class C" drivers license upon employment and must obtain a CDL "Class B" drivers license within six (6) months of hire date. Must be available to work weekdays, evenings and weekends. Skilled in the use of tools, and material commonly used in building cleaning and light maintenance. Considerable amount of public contact requiring patience and in some cases, firm direction and control to enforce rules and regulation. Good judgement is a must. Ability to work under little direction.

PHYSICAL ACTIVITIES

Very

Important

Important

Slightly

Important

Not

Important Standing X Sitting X Walking X Lifting X Pushing\Pulling X Carrying X Climbing X Kneeling X Crawling X Bending at waist X Reaching X Handling objects X Repetitive motion X Use of arm muscles over extended periods

X

Use of leg muscles over extended periods

X

Overhead work X Stationary desk or bench work

X

Ability to lift 50 – 75 lbs from 0 – 5 feet off the ground for distances of up to 50 feet Requires working outdoors and indoors, operating forklifts, dangerous machinery and vehicles, working with chemicals near fumes and vapors.

CITY OF CHAMPLIN JOB DESCRIPTION

Date: August, 2015 POSITION CLASSIFICATION: Public Service Worker –

Public Works Streets & Parks DEPARTMENT: Parks and Public Works ACCOUNTABLE TO: Public Works Operation Foreman POSITION STATUS: Regular Full-Time (Non-Exempt; Union) JOB SUMMARY Under the supervision of the Public Works Supervisor, this position will perform maintenance tasks and operate maintenance equipment used in the maintenance of streets, parks and other public facilities of the City. DUTIES & RESPONSIBILITIES

1. Plow and ice control operations of sidewalks, streets, parking lots and trails.

2. Installs and repairs signs and barricades. Lay out and apply street traffic markings with various types of paint, machinery and stencils.

3. Performs crack sealing, patching on streets, trails and parking lots.

4. Hauls materials manually and/or using equipment.

5. Picks up litter and empties trash containers on City and public land.

6. Maintains irrigation systems within the park system and other public areas.

7. Maintains turf including mowing, fertilizing, spraying, and aerating.

8. Installs, repairs, and maintains outdoor ice rinks.

9. Maintains plants, trees, shrubs, and plant care projects and transplants trees.

10. Prepares ground for seed, sod and plantings.

11. Performs cemetery maintenance including digging graves.

12. Maintains municipal buildings and grounds.

13. Operates equipment including but not limited to loaders, backhoes, skid steers, sweepers, mowers, forklifts, compressors, sprayers, heavy trucks etc.

14. Other duties as assigned.

KNOWLEDGE, SKILLS, & ABILITIES Considerable knowledge of methods used to maintain city facilities (i.e. parks, streets, City Buildings etc.) Ability to read and interpret plans and blueprints. Ability to follow standard safety practices and procedures commonly associated with maintenance and repair activities Ability to keep routine records and communicate effectively. Ability to establish and maintain effective working relationships with employees, other departments and the public. Respond willingly to varied work assignments. Respond willingly to flexible working hours to facilitate meeting desired conditions of City parks, streets, and City Buildings. Ability to obtain any licenses required by law or the City to perform work assignment. QUALIFICATIONS Must be 18 years of age and a graduate from high school or G.E.D. Position requires a valid "Class D" drivers license upon employment and must obtain a CDL "Class B" drivers license within six (6) months of hire date with endorsements. Experience in a municipal setting or equivalent with knowledge of practices, procedures, equipment and materials used in streets and parks maintenance and construction. Vo-Tec training or equivalent in trade skills (i.e. carpentry, electrical, plumbing, welding, cement finishing, turf maintenance, landscaping & horticulture) Skill in the operations of light and heavy construction and maintenance equipment. Ability to understand and follow oral and written instructions. Ability to perform strenuous work under varying weather conditions. Working knowledge of general buildings and grounds construction and maintenance work, tools and equipment. Knowledge of the safe methods and materials used in the maintenance of all City streets and parks. Public Works Certificate or equivalent desirable

PHYSICAL ACTIVITIES

Very

Important

Important

Slightly

Important

Not

Important Standing X Sitting X Walking X Lifting X Pushing\Pulling X Carrying X Climbing X Kneeling X Crawling X Bending at waist X Reaching X Handling objects X Repetitive motion X Use of arm muscles over extended periods

X

Use of leg muscles over extended periods

X

Overhead work X Stationary desk or bench work

X

Ability to lift 50 – 75 lbs from 0 – 5 feet off the ground for distances of up to 50 feet Requires working outdoors and indoors, operating forklifts, dangerous machinery and vehicles, working with chemicals near fumes and vapors.

1

Education, Training, Skills & Knowledge Self Assessment

Public Service Worker: Streets & Parks/Ice Forum Item

# Item

1 Graduation from HS or GED Yes No 2 Professional full-time experience in Street, Park, or Arena

maintenance work in a municipal setting or equivalent Yes

No

Describe how you meet this requirement, number of

months doing this work:

3 Public Works Certificate or equivalent Yes No Describe how you meet this requirement: 4 Minnesota Class D Drivers License Yes No 5 Minnesota Commercial Drivers License Class B Yes No 6 Minnesota Commercial Drivers License Class A Yes No 7 Minnesota Commercial Drivers License Endorsement for

Tankers Yes No

8 Minnesota Commercial Drivers License Endorsement for

Doubles and Triples Yes No

9 Minnesota Commercial Drivers License Endorsement for

Air Brakes Yes No

10 Minnesota Non-Commercial Pesticide Applicators

License Yes No

11 Vo-Tech training or professional experience in basic

carpentry, plumbing, electrical, welding. Yes No

Describe how you meet this requirement, number of months doing this work:

2

12 Professional experience setting up rooms for meetings,

custodial, events, banquets, etc. Yes No

Describe how you meet this requirement, number of months doing this work:

13 Vo-Tec training or professional experience with

commercial refrigeration systems. Yes No

Describe how you meet this requirement, number of months doing this work:

14 Vo-Tec training or professional experience maintain

artificial ice. Yes No

Describe how you meet this requirement, number of months doing this work:

15 Professional experience operating a ice resurfacer (i.e.

Zamboni). Yes No

Describe how you meet this requirement, number of months doing this work:

16 Vo-Tech training or professional experience in

landscaping / horticulture / turf maintenance Yes No

Describe how you meet this requirement, number of months doing this work:

17 Professional experience maintaining, designing, or

installing commercial irrigation systems Yes No

Describe how you meet this requirement, number of months doing this work:

3

18 Experience supervising staff. Yes No Describe how you meet this requirement, number of

months doing this work:

19 Experience handling cash, cash register, etc. Yes No Describe how you meet this requirement, number of

months doing this work:

20 Professional experience operating backhoe loaders /

articulating front end loader / motor grader / street sweepers, skid loader (Elgin).

Yes No

Describe how you meet this requirement, number of months doing this work:

21 Professional experience sharpening skates. Yes No Describe how you meet this requirement, number of

months doing this work:

22 Professional experience operating Toro 580D, Toro

Groundmaster 52” or 72” lawn mowing equipment or equivalent

Yes No

Describe how you meet this requirement, number of months doing this work:

23 Professional experience in bituminous repair, cracksealing, paving, patching, cement finishing

Yes No

Describe how you meet this requirement, number of months doing this work:

4

24 Professional experience responding to needs of customers in a positive manner.

Yes No

Describe how you meet this requirement, number of months doing this work:

25 Professional experience operating park utility tractors with

attachments (seeders, drags, fertilizer spreaders, blowers, brooms, shaver, flail mower, aerators)

Yes No

Describe how you meet this requirement, number of months doing this work:

26 Professional experience operating single\tandem axle

trucks with plow, wing, and sander or trackless sidewalk machine or equivalent including attachments (i.e. blower, v-plow, broom)

Yes No

Describe how you meet this requirement, number of months doing this work:

27 Professional experience operating trackless sidewalk

machine or equivalent including attachments (i.e. blower, v-plow, broom)

Yes No

Describe how you meet this requirement, number of months doing this work:

28 Professional experience maintaining municipal storm

sewer systems to include inspections, cleaning, pipe repair, catch basin repair, and manhole repair

Yes No

Describe how you meet this requirement, number of months doing this work:

29 Professional experience maintaining outdoor hockey and

pleasure skating rinks (cleaning, flooding, shaving) Yes No

Describe how you meet this requirement, number of months doing this work:

5

30 Professional experience maintaining cemetery including

locating and digging graves Yes No

Describe how you meet this requirement, number of months doing this work:

31 Professional experience layout and striping athletic fields

(i.e. soccer, football, baseball, softball) Yes No

Describe how you meet this requirement, number of months doing this work:

Applicant’s Statement

I certify that answers herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this education, training, skills & knowledge self assessment for employment as may be necessary in arriving at an employment decision. I understand that this rating is not, and is not intended, to be a contract of employment.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the City.

Signature of Applicant Date Print Name

CITY OF CHAMPLIN 11955 Champlin Drive Employment Application

Champlin MN 55316

POSITION APPLIED FOR: PUBLIC SERVICE WORKER - ICE FORUM/STREETSAPPLICANT INFORMATION

Last Name First M.I. Date

Street Address Apartment/Unit #

City State ZIP

Phone E-mail Address

Date Available to Start Type of Work: Full Time Part Time Seasonal

Are you a citizen of the United States? YES NO If no, are you authorized to work in the U.S.? YES NO

Have you been employed here before? YES NO If so, when?

Have you ever been convicted of a felony? YES NO If yes, explain

EDUCATION

High School Address

Did you graduate? YES NO Degree

College Address

Did you graduate? YES NO Degree

Other Address

Did you graduate? YES NO Degree

Additional Training:

REFERENCES Please list three professional references.

Full Name Relationship

Company Phone ( )

Address

Full Name Relationship

Company Phone ( )

Address

Full Name Relationship

Company Phone ( )

Address

PREVIOUS EMPLOYMENT (DO NOT USE “SEE RESUME” – ATTACH ADDITIONAL SHEETS IF NECESSARY)

Company Phone ( )

Address Supervisor

Job Title Starting Salary $ Ending Salary $

Responsibilities

Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

Company Phone ( )

Address Supervisor

Job Title Starting Salary $ Ending Salary $

Responsibilities

Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

Company Phone ( )

Address Supervisor

Job Title Starting Salary $ Ending Salary $

Responsibilities

Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

Company Phone ( )

Address Supervisor

Job Title Starting Salary $ Ending Salary $

Responsibilities

Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

PREVIOUS EMPLOYMENT (DO NOT USE “SEE RESUME” – ATTACH ADDITIONAL SHEETS IF NECESSARY)

Company Phone ( )

Address Supervisor

Job Title Starting Salary $ Ending Salary $

Responsibilities

Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

Company Phone ( )

Address Supervisor

Job Title Starting Salary $ Ending Salary $

Responsibilities

Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

Company Phone ( )

Address Supervisor

Job Title Starting Salary $ Ending Salary $

Responsibilities

Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

ADDITIONAL TRAINING/RELEVANT PROFESSIONAL MEMBERSHIPS

DRIVERS LICENSE/RELEVANT PROFESSIONAL LICENSES Drivers License No. State Issued In Class

Professional License Expiration Date

Professional License Expiration Date

DISCLAIMER AND SIGNATURE I certify that the information provided in this employment application is true and complete to the best of my knowledge. I understand that any false or incomplete information may disqualify me from further consideration for employment and may result in my immediate discharge if discovered at a later date.

I understand and acknowledge that unless otherwise defined by applicable law or written agreement with the City of Champlin, any employment relationship with the City of Champlin is considered “employment at will”. This means the Employee may resign at any time and the Employer may discharge the Employee at any time, with or without cause, and with or without advance notice.

I authorize the investigation of any and all statements contained in this application and also authorize any person, school, current employer, past employers, and other organizations to provide information concerning my previous employment and other relevant information that may be useful in making a hiring decision. I release such persons and organization from any legal liability in making such statements.

I have read, understand and agree to the above statements.

Signature Date

TENNESSEN WARNING Information requested on your application defined by State Statute as public may be released on request and includes job history, education and training, and work availability. Your name is private except when you are certified as eligible for appointment to a vacancy. Certain other information requested on your application is private and may be released only to you or to governmental entities authorized access by law (MS 13.04 Subd. 2.). Private data contained above:

Name: Used to identify you in relation to other applicants. You are legally required to provide your name. Failure to provide this information may result in a delay in processing or rejection of your application.

Local/Permanent Address/Home Telephone: Used to contact you regarding your application’s status. You are not legally required to provide this information. Failure to provide this information may result in a delay in processing or notifying you of your application’s status.

License Information: Used to certify applicants for positions where State law requires appropriate license. You are legally required to provide this information. Failure to provide this information may result in your rejection as an applicant for this position.

Citizenship Status: Used to certify applicants for work in the United States as determined by laws of the United States Department of Labor and the State of Minnesota. Failure to provide this information may result in rejection of your application.

NOTE: The City of Champlin is an equal opportunity employer. Qualified applicants are considered for all positions without regard

to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a disability, or any other protected status under applicable federal, state or local law. Those applicants requiring a reasonable accommodation to the application and/or interview process should notify the Administration Department at (763) 421-8100.

A public employer may not inquire into or consider the criminal record or criminal history of an applicant for public employment until the applicant has been selected for an interview by the employer. An applicant for employment with the City of Champlin and selected for an interview may be required to undergo a criminal history background check. A conviction will not necessarily disqualify you from employment with the City; circumstances of the conviction will be taken into consideration. If you are selected for an interview, you will be required to provide an authorization for release of information that is necessary to conduct a background check.

ALL APPLICANTS MUST FILL OUT THIS FORM TO BE CONSIDERED FOR A POSITION. EVEN IF YOU ARE NOT A VETERAN, YOU MUST

CHECK “NO” BELOW AND SIGN AND DATE THE FORM

CITY OF CHAMPLIN VETERANS PREFERENCE APPLICATION

NAME: ______________________________________ Are you applying for Veterans Preference Points? _______ YES _______ NO VETERANS PREFERENCE REQUESTED: [ ] Veteran (DD214 or DD215 must be attached) [ ] Disabled Veteran (DD214 and Letter from VA of proof of disability must be attached) [ ] Spouse of Disabled Veteran (DD214 and Letter from VA of proof of disability must be attached) [ ] Spouse of Deceased Veteran (Attach DD214 or DD215, photocopy of marriage certificate and spouse’s death certificate. If you have remarried or were divorced from the veteran, you are ineligible). Your preference points application cannot be considered without supporting documentation (see above). AFFIDAVIT: I hereby claim Veterans’ Preference for this position and swear/affirm that the information given is true, complete and correct to the best of my knowledge. I hereby authorize the Veterans Administration to release information necessary to process this application to the City of Champlin. ________________________________________ ________________________ Signature Date Thank you for your military service and for your interest in employment with the City of Champlin. Please contact our office at (763) 421-8100 or your local County Veterans’ Service Office, if you have any questions regarding veterans’ preference in public employment.

VETERANS PREFERENCE Preference points are awarded to qualified veterans and spouses of deceased or disabled veterans, subject to the provisions of MN Statute 197.447. The veteran must: a) be a U.S. Citizen or resident alien, b) have received a discharge under honorable conditions from any branch of the U.S. Armed Forces; AND have either: i) served on active duty for at least 181 consecutive days, or ii) have been discharged by reason of service connected disability, or iii) have completed the minimum active duty requirement of federal law, as defined by CFR Title 38, Section 3.12a (i.e. having fulfilled the full period for which a person was called or ordered to active duty by the United States President), or iv) certified service and verification of “veteran status” granted U.S. PL 95-202. The information provided will be used to determine your eligibility for veterans’ preference points. You are required to supply the following information: 1. Attach a copy of the DD214 or DD215. This copy must state the nature of the discharge (i.e. honorable, general, medical, under honorable conditions). DD214 “Member-1” copy will not be accepted. 2. Disabled veterans must also supply a Military/United States Department of Veterans’ Affairs Rating Decision that supports/verifies the fact that the injury was incurred while on, or as a result of, active duty service. Disability incurred while on, or as a result of, active duty for training purposes does not qualify for disabled veteran preference, per MN Statute 197.455. 3. A spouse of a deceased veteran applying for preference points must supply their marriage certificate, the veteran’s DD214 or DD215, a death certificate, verification of their marriage at the time of veteran’s death, and that the spouse has not remarried.