Paxton Lindt
Date Received: 1p —
SCANDIA The City of Scandia welcomes you as an applicant for employment.
It is the policy of the City of Scandia to provide equal opportunity to all employees and applicants for employment. The City of Scandia
will not discriminate against or harass any employee or applicant for employment because of race, color, creed, religion, national origin,
sex, disability, age, marital status, sexual orientation, or status with regard to public assistance. Our employment decisions are made
on the basis of individual ability and merit. Upon request, accommodations will be provided to applicants in accordance with American
with Disabilities Act (ADA). Please call (651) 433-2274.
Applicant's Last Name
First AXE Middle
Position Applying For: __Rb tt C' 1J oY &' S -puft4-6Ve
APPLICATION INSTRUCTIONS:
To ensure that your application will be accurately processed, please review the following:
(1) Please print or type when completing this form.
(2) Complete a separate application form for each position opening you apply for, following
instructions completely and signing your application where required.
(3) There may be a supplemental application with additional questions for the position,
which must be submitted in order for your application to be considered complete.
(3) Be specific and complete when filling out the Employment History section. Application
forms that are incomplete will be removed from further consideration. If additional space
is needed to complete your employment history, you may make copies of that page. A
resume may be attached to the completed application.
(4) Applications must be received by the advertised closing date and time. You may fax or
e-mail a copy of your application by the deadline, but the original should be received in
our office not later than one week following the closing of the application period. When
the stated deadline is past, all applications will be reviewed and evaluated to determine
how well each applicant is suited for the position opening.
(5) Interviews will be conducted by the City Administrator and/or the City Council. Others
may be involved as needed. After discussion, they will select the best applicant for the
position.
(6) The City Administrator will inform the successful applicant and arrange a starting date.
Applicants will be notified by mail that the position has been filled.
RETURN COMPLETED APPLICATION FORM TO:
Neil Soltis, City Administrator
City of Scandia
14727 209th St. N.
Scandia, MN 55073
Telephone: (651) 433-2274
Fax: (651) 433-5112
E-mail: n.soltis(cbci.scandia.mn.us
♦ TENNESSEN WARNING
In accordance with the Minnesota Government Data Practices Act, the City of Scandia is required to
inform you of your rights as they relate to the private information collected from you. Private data is
information that is available to you, but not the public. The personal information we collect about you
is private. Minnesota Statutes 13.04 and 13.43 are two sections that govern what affects you as an
applicant for employment with the City of Scandia. All data collected is considered private except for
the following:
(1) Your veteran's status.
(2) Relevant test scores.
(3) Your rank on our eligibility list.
(4) Your job history.
(5) Your education and training.
(6) Your work availability.
Your name is considered private information; however, if you are selected to be interviewed as a
finalist, your name becomes public information.
The data supplied by you may be used for such other purposes as may be determined to be
necessary in the administration of personnel policies, rules, and regulations of the City of Scandia.
Furnishing social security numbers, date of birth (unless a minimum age is required), sex, age group,
and disability data is voluntary, but refusal to supply other requested information will mean that your
application for employment may not be considered.
Private data is available only to you, appropriate City employees, and others as provided by state and
federal law who have a bona fide need for the data. Public data is available to anyone requesting it
and consists of all data furnished in the application for employment that is not designated in this notice
as private data.
Except for race, sex, age, and disability data, the information you give us about yourself is needed to
identify you and to assist the City of Scandia in determining your suitability for the position for which
you are applying. Race, sex, age, and disability data are used in summary form by the City of Scandia
to monitor protected class employment and to meet federal, state, and local reporting requirements.
I declare that I have read and understand the information given above regarding the Minnesota Data
Practices Act.
Applicant's Printed Name: ,�X / °'v Y � :J
Applicant's Signature: (�)
Date: 9- /-2 1
♦ PERSONAL INFORMATION
NAME / ADDRESS / PHONE:
Last Name: First Name:'q%''t)
XMiddle: To y
Address: IGSa0 %WIZ'OM S A)O
City: &M5 i- y State: 01A-) Zip: 5"� G .1
Telephone: &51 900 a q,?- Between hours of -Y°O ipni and /-1aJL
Telephone:
Between hours of
and
Email jgr 'o�eno,;1.(o- r
Areyou under 18 years of age?........................................................................................ JKNo ❑Yes
If so, are you 16 years of age or older?........................................................ .... *-Ik........
❑ No ❑ Yes
EDUCATION
Educational
Institution Name and Address of Institution
High ,NDfZTN BIZRAt-# 69 VrW /Jr -H
School
College LNKf 30psRrai(2 CC'UfGf
College
Othhecify) T1_Ar VT 6- Fxeyn M,Q w A
DRIVER'S LICENSE
Course Level of
(Major/Minor) Education
A; W GWI<
�u?1D T�clf
Did you List Diploma or
Graduate I Degree Awarded
(,Qnly complete this section if a driver's license is reouired for the position you are applying for. )
Driver's License # F-. 5/4SD-5-/V ?'2J,5 /,3 License Class (A, B, C, D) JI < L
State in which license is issued: A) . _ Expiration Date: 1d -0q --?0f9
OTHER LICENSES & CERTIFICATES
Please list any other licenses, registrations, or certifications that are required or pertinent to the position you are applying for. If this
licensing, etc., is required for the position, and you fail to include a photocopy of it with your application form, your name will be removed
from further consideration for the position. If this licensing is not required for the position, but you feel it is relevant and may be an item
for which we are awarding points, please indicate below for credit to be awarded.
Type of License or Certificate
CLW 6 Wt+FktL
Licensing Agency
MM
Expiration
Date
Roy
License Number
CL w sr�� Tf
O�
♦ EMPLOYMENT HISTORY
♦ The City of Scandia uses a 100 -point system to assign value to the experience and training that relates
most closely to the position you are applying for. Your experience and training will be scored using the
experience and training value system designed for this position. Those applicants (typically the top 6 to 8)
with the highest number of total points will be advanced for additional consideration.
♦ In order to receive the correct points and credit for the knowledge and skills you have acquired, it is
absolutely necessary that you are specific when describing these skills. Do not use a single general
statement to describe the duties you have performed. List each major duty performed for each position
held within the past five years. Whether you are describing your experience as a clerical worker or a truck
driver, list each duty separately and be specific. Describe duties in specific terms, such as "performed
word processing using Word," or "operated forklift, front end loader, and back hoe." Statements such as
"performed general clerical work" or "operated heavy equipment" are too general.
♦ Please be specific in stating the dates of employment and number of hours you worked per week for each
job experience indicated. We need this information to properly score your experience. If hours worked per
week vary, please use the average number of hours worked per week.
♦ Complete the boxed in "Length of Employment" section only for positions held within the past five years,
but please do include all of your relevant work experience in the Employment History section.
♦ Please give accurate and complete information. List your present or most recent experience first.
* DO NOT MARK YOUR APPLICATION "Please see resume." *
PRESENT OR MOST RECENT EMPLOYER
Employer:
"f Y 04� ��
Employer Address:
Employer Phone Number:
Supervisor's Name & Title
�� 5--AFTfg- A5T7TPrJ -rS -OF
May we contact this employer? ❑ No ❑ Yes
Your Job Title: W651 -f- k.)An,Q OP Average Number of Hours Worked per Week:
Numbers and types of positions you supervised:
Reason for Leaving: 1VoVJ--VC,
Your Duties & Responsibilities: 26h wz424-4 J c9rd LrFT'
S f � i�'F�ril � /�I�1�v 'f�C� �- �C � t�� �I� � ,vow ��►K �� =4" (�
�,��� Qxo,5ocs� .Sf' q OZOLL ► ' C'J�iT,� Ct -r cry' CJ54, L ,�9C t�T�,l,
Dates of Employment:
If less than 5 years acro, indicate dates of employment
-9-17-15--
(month
-l7-15—
(month & year)
to Lhl
(month & year)
If rr v^ #k�n L'. %j^. ro � ^r%ki k^%ai I^n^ v^i a %u^rte rA +ke%r^• vo�re m^n+k
PREVIOUS EMPLOYER
Employer: CrT or— ovD, Q May we contact this employer? ❑ No A Yes
Employer Address: 0 W #Tx% �_ .5_e 0 & pc?
Employer Phone Number: dl JF 71 ",kRe
Supervisor's Name & Title: e00,Vt 1- <if- 046 y0 '-
Your Job Title: s 2'V1,se"verage Number of Hours Worked per Week:
Numbers and types of positions you supervised:
Reason for Leaving: M web _
Your Duties & Responsibilities: ffTZ(L q- Sxk,e_ ._ OZj ieff
0970 (IN r9vX-P ►tet ilV T
Dates of Employment:
101AAC4L_
If less than 5 years ago, indicate dates of employment: ___T_A� 0 ? to /46 /,5 --
(month & year) (month & year)
If more than 5 years ago, only indicate how long you worked there: _years $ months
PREVIOUS EMPLOYER
Employer: i2ill({J,$ 0r0 099 May we contact this employer? ❑ No LfflYes
Employer Address: IV j RA.TL (-a6V5 j4L1,� Moto'
Employer Phone Number: 1 73 y 7ro
Supervisor's Name & Title: pQ f IffboQ
Your Job Title: � A35,PLFAM, tr�£� Average Number of Hours Worked per Week:
Numbers and types of positions you supervised:
Reason for Leaving: _tWO Eh
Your Duties & Responsibilities: J,9tf3 ,
Dates of Employment:
If less than 5 years ago, indicate dates of employment: ✓� /% - /% to
(month & year)
If more than 5 years acro, only indicate how long you worked there: _ years
JVIV 15__
(month & year)
months
PREVIOUS EMPLOYER
Employer:—d—,5 tlly iaov-� May we contact this employer? o ❑ Yes
Employer Address:
Employer Phone Number:
Supervisors Name & Title:
Your Job Title: cvMpUr
2 V/0
Numbers and types of positions you supervised:
Average Number of Hours Worked per Week: 40
Reason for Leaving: L Ay na-F
Your Duties & Responsibilities: $Ri4t9 b Pwj--raZE(- `,- .5,W F/ d j 5, pyo P
Dates of Employment:
If less than 5 years ago, indicate dates of employment: V— Lex to /P _
(month & year) (month & year)
If more than 5years ago, only indicate how long you worked there: _ years months
PROFESSIONAL REFERENCES
List people who know you well, preferably from a work environment and not an acquaintance or relative.
Name QDT—O&v-ti� Address
Home Phone
Work Phone Occupation ErjeL.. C
Name Oua�v...6a i mfr Address
Home Phone 600 7 3� 1 1113
Work Phone
04 ' ti
Occupation P-rr Sop'kQyrSe'e
Name/,1Cy 7iB-ke. G Address
Home Phone rf-oays IfKls
Work Phone _�7 770 Occupation
ML
C fif /V/V L
♦ CRIMINAL HISTORY/ BACKGROUND CHECKS
The City of Scandia conducts criminal history and driving license background checks on all regular full-
time or part-time employees. The City may also conduct criminal history or driving license background
checks on temporary or seasonal employees in positions which work directly with children or
vulnerable adults, positions which involve driving as part of the duties, and positions which work
directly with financial records and cash receipts.
Background checks will be generally be conducted after an interview has taken place, but before a
conditional offer of employment is made. For positions within the Fire Department, background
checks may be conducted prior to an interview and any other testing that may be required as part of
the hiring process.
For all positions, the city will look at the type of conviction and whether it is directly related to the job
for which you are applying.
Candidates for positions working with children will not be selected if they have been convicted of any
crime listed in the Child Protection Worker Act (Minnesota Statutes 299C.61 & 62). Generally, this
includes child abuse crimes, murder, manslaughter, felony level assault or any assault crime
committed against a minor; kidnapping, arson, criminal sexual conduct, and prostitution -related
crimes.
Before any applicant is rejected on the basis of criminal conviction, he or she will be notified in writing
and will be given any rights afforded by Minnesota Statutes Chapter 364. This includes the right to
show evidence of rehabilitation.
I declare that I have read and understand the information given above regarding criminal history and
background checks.
Applicant's Printed Name:
Applicant's Signature , Date: 9 /07 -`IG
♦ CLAIM FOR VETERAN'S PREFERENCE
The eligibility requirements for veteran's preference are listed below. Read them carefully to see if you qualify. If you do wish to
receive preference, be sure to complete this section. Providing the information in this section is voluntary. You must do so if you wish
to obtain the preference.
Veteran Eligibility for Open Competitive Position (5 Points)
Must be a U.S. Citizen or resident alien who has separated under honorable conditions:
(1) After serving on active duty for 181 consecutive days, or
(2) By reason of disability incurred while serving on active duty.
Disabled Veteran Eligibility for Open Competitive Position (10 Points)
Must have a compensable service connected disability as adjudicated by the United States Veteran's Administration or by the
Retirement Board of the several branches of the armed forces and the disability must exist at the time preference is claimed.
Disabled Veteran Eligibility for Promotional Position (5 Points)
Must, at the time of election to use preference, be entitled to disability compensation for a permanent service -connected disability rated
at 50% or more and the position for which you are applying must be the first promotion after entering public employment.
Eligibility as a Spouse of a Deceased or Disabled Veteran
Must be a spouse of either a deceased veteran or the spouse of a disabled veteran who, because of a disability, is unable to qualify for
the particular position due to his/her disability and who would have or does meet the criteria for one of the above -listed preferences.
ALL APPLICANTS CLAIMING VETERAN'S PREFERENCE MUST ATTACH A COPY OF HIS/HER FORM DD214 FAILURE TO DO
SO MAY RESULT IN LOSS OF VETERAN'S PREFERENCE ELIGIBILITY.
City of Scandia Veteran's Preference Claim Form
For V.A. Use Only: Is the veteran named below rated as having a compensable service -related disability?
❑ No ❑ Yes % of Disability _ By
Date
Name of Veteran (last — first — middle)
Name of Applicant — if different than veteran (last — first — middle)
Address City State Zip
Classification
To Be Completed by Veteran or Spouse of Deceased Veteran
(1) Are you a U.S. Citizen or resident alien?... ... .......... ...... .................................. ............. ......... ...... ...... El No Fl Yes
(2) Were you honorably discharged from military service?...................................................................................................❑ No ❑ Yes
(3) Were you separated from military service after serving active duty for at least 181 consecutive days? .... ........ .............. ❑ No ❑ Yes
(4) Do you currently have a compensable service -related disability?...................................................................................❑ No ❑ Yes
(5) Branch of Service Date of Discharge Serial Number
Type of Separation Date of Entry
For spouse of deceased veteran, date of death
If Spouse of Disabled Veteran, please answer the following:
If spouse is disabled, please explain why your spouse does not qualify for this position:
Claim Number (if disabled) State Claim is Filed In
': J
Signature of Veteran Social Security Number Date
♦ EMPLOYEE CERTIFICATION
Before signing this application, please read the following waiver carefully.
(1) 1 have read and understand the job announcement for the position for which I am applying and
certify that the answers given in this application are true and complete to the best of my
knowledge.
(2) 1 authorize all current and previous employers to release job-related information upon the
written request of the City of Scandia. However, I understand that if, in the Employment History
section, I have answered "No" to the question, "May we contact this employer?," contact with
the employer will not be made without my specific authorization.
(3) 1 authorize the City of Scandia to verify all information on this application to determine whether
or not I am qualified for the position for which I am applying.
(4) 1 understand that providing false information on this application may result in dismissal from any
position gained on the basis of that false information.
Applicant's Printed Name:
Applicant's Signature:%�
Date:
! BEFORE YOU SUBMIT YOUR APPLICATION, HAVE YOU .....
0 Thoroughly read this entire application with special attention to the Tennessen Warning?
Q Signed this application in all the required places? This application will not be accepted without all
necessary signatures.
• Tennessen Warning
• Criminal History/ Background Checks
• Claim for Veteran's Preference, if applicable
• Employee Certification
EI Provided sufficient information so that proper credit for training and experience are given?
0 Completed the claim for Veteran's Preference if applicable to you? Also, a copy of your
Form DD214 must be submitted at the time of application to determine your eligibility for points.
El Included copies of all required licensing and/or certifications?
9/05
The City of Scandia needs your cooperation in the completion of this form. It will enable the City to report accurate
information to both the State and Federal governments.
♦ AFFIRMATIVE ACTION APPLICANT INFORMATION
To All Applicants:
The following information in no way affects you as an individual applicant. This information will be
used to find out how effective our recruitment efforts are in reaching all segments of the population
and in validation of our selection methods. The information will not be maintained in personnel files
and it will not be made available to any person involved in decisions affecting an individual's
appointment or promotion to a position. Although providing this information is voluntary, it is
important that all applicants answer these questions so that we may take steps to prevent
discrimination in the recruitment and selection of employees for public service.
Position Applying For:
Department:
1
Instructions: Check the choice that answers each of the following questions.
(1) What sex are you? WMale ❑ Female
(2) Of the following, of what racial/ethnic group do you consider yourself?
American Indian/Alaskan Native
African American
Asian and Pacific Islander
Spanish or Mexican American
D White
Other
(3) Do you have a disability? &No F] Yes
(4) How did you learn about this job opening?
Country Messenger
Forest Lake Times
St. Paul Pioneer Press
_X League of MN Cities Website
City Employee
City Website
Walk -In
Posting at Community Center
Other (be specific):
1� Position: Public Works Director
SCADIAPlease furnish as complete information as possible, attaching additional
pages if necessary. This form is part of your employment application.
# SUPPLEMENTAL APPLICATION
Applicant's Last Name Z-7�t)D First � Middle T)9
1. Describe your knowledge of and experience with road construction and maintenance.
1)6vt- C U'I � ����/}GCort �12f i T li%c-/t AF f1OCES 4N,� S .vim hb�
.� il�v� us£� /�rwlxx �NrJ
�Al M#AJ #vLt,s .
2. Describe your knowledge of and experience with operation and maintenance of heavy equipment
as employed in road, drainage and other public works projects.
1 r/40t, /SAW)-,gr,vfb j4ab , #A) A- �oi�l�i��ef �W (
)qA;d) A177f WV()la&V lt,1J4:PV& &-p &940fc- OA) 4#451 r pfivL uss vsAto�S YP�3
0%"p 1 sc 04145 , h"t o TTB'" 2Art,4�5, o� FR�� �qutOMt�ri BACK 1,65.,rli/A �� Exif�r�rd�
kW00Cj �G J- T,) M#T01CA,�iy« A,�liJQt fPj � end vftrooS 'QX)rflq"Vr
3. Describe your knowledge of and experience with building and grounds maintenance.
M Y Cn��arFNG� is 9'>'�rte,5 RgPArQS t9N PREK 6vri-D-',06 sr e£'Fr«,,
67L?0vt SSS N -Li i>VT L�(5-&k &TIHM00 r'gervl 61-oKIA) WftTfe- �ra�s �'o �tfcTRzcAL
�wxA - �¢LSv N���, �,rr��vcrV� fx�EQrgV4j. ja/ lkooinv(;1 SPP-AYrd)
f/} -I< QE/, om!r , '761 r1h* •r.vb , STQs ET ZT61fT Qf,pATeS, T/�i- ZSS 7—
it
4. Describe your knowledge of and experience with developing and implementing policies for
operation and maintenance of public infrastructure (such as pavement maintenance, snow and ice
control, sewer and/or water systems) or equipment.�+ p
l� STI3�Tjl� TA) o7Da�, '!N£Qi 0�-Oe'- t�rJ T 0� �fS
��J Ta �,N�1£.K FyT �4 S £w� 2
LLt
jtiaurs_ B9cr�Q. �qrM 1. 14150 r Ps An9D S
ci rYVu c2 HA D oA) t7 r 9910 7h�
> Z�!
5. Describe your knowledge of and experience with subsurface sewage treatment systems or water
systems.
6. Describe your knowledge of and experience with work safety standards and implementation of
OSHA regulations.
OS N�} rZ�Gty Lir Sr .2 Q7 ��E � s0V
9 FJrje r
7. Describe your supervisory experience, including the positions and number of employees
supervised.' %����-50P���S��'\f ,lifr"'!LTIi�I1 f�_ Awl Sf'sT£�%1j
T gAJ i S vpCp-VrS jt>j 4Nb T i U L/tAb !n r LkPLa,eff l.v THE C'-rf W ()VU4LAnV)
Applicant's Last Name ZTA) 1
Applicant's Signature: X
4
First 1 XY TOX-) Middle -Tri �
Date:-/9���
Paxton J. Lind
16520 Da um Street NVQ
Ramsey, MNS5303
651900-1292
Email: pax 28@hotmail.com
Objective -
To obtain a job with the city using my waste water and water management
Certification background and experience to excel in my career.
Qualification Highlights-
❖ Waste Water Class C License.
•'• Water Class C License.
❖ MN Class A CDL with tanker endorsement.
•'• Experience in automotive mechanical repair.
•3 Water and sewer lab testing background.
❖ Heavy equipment operations and repair.
•'• Street maintenance experience and park maintenance.
❖ Building maintenance experience.
Employment History -
2015 -Present, City of North Branch, Waste Water Operator/ Public Works
Testing labs of water and waste water, processing labs. Chemical tests of
sewer/water. Maintaining of heavy equipment and operations. Performing on call
rotation with other public works staff and problem solving emergency calls for
water and also city maintenance.
2007-2015 City of Underwood Maintenance Supervisor/Waste Water Manage
Management of water system and maintenance of roads. Overseeing 5 city
employees. Water level maintaining and PH levels monitoring and testing of
water and sludge maintenance. Upkeep of city trucks and heavy equipment.
Maintenance of roads.
2005-2007, Ashby Equity, Commercial Applicator
Spreading granulated pesticides and fertilizer on farmer's field and maintaining
heavy equipment trucks.
2002-2005, Mark Sand and Gravel, Heavy Equipment Operator
Hauling gravel and concrete to various building sites and dump. Running front end
loaders and off road dump trucks. Maintenance of heavy equipment.
References available upon request.