Election Form No Employer ContributionsPublished Feb 27, 2015
This Flexible Benefit Election Form No Employer Contributions is to be used in conjunction with the Flexible Benefit Plan Basic Plan Document.
Change in Election FormPublished Feb 27, 2015
This is the Change in Election Form that is to be used in conjunction with the Flexible Benefit Plan Basic Plan Document.
Election FormPublished Feb 27, 2015
This Flexible Benefit Election Form is to be used in conjunction with the Flexible Benefit Plan Basic Plan Document.
Medical Expense Reimbursement FormPublished Mar 23, 2012
This is the Medical Expense Reimbursement Form to be used in conjunction with the Flexible Benefit Plan Basic Plan Document
Hepatitis B Vaccination Declination, LMC Model FormPublished Oct 4, 2017
A city must offer its employees vaccination for hepatitis B if they are at risk of exposure to bloodborne pathogens as part of their regular duties. An employee may decline, but must sign this special form to document refusal.
Local Gambling Permit Application, LMC Model FormPublished Jul 20, 2018
Application form for use in cities that require a local gambling permit for conducting bingo, raffles, paddlewheels, tipboards and pull-tab operations that meet conditions for exemption from state licensing requirements.
Variance Application, LMC Model FormPublished Jan 11, 2019
Suggested form for a property owner to apply for an exception – or variance - from a requirement in the city’s zoning ordinance.
Training and Experience Rating Sheets, LMC Model FormPublished Mar 22, 2017
Worksheets for evaluating job applicants for many common city positions by allocating points for qualifications the city determine are required, minimum and desired education and experience. The calculation includes veterans preference points as applicable, and provides a total for qualification-based rankings to identify your interview pool. The use of Supplemental Application forms help the city obtain consistent information for ranking of all candidates.
Supplemental Applications, LMC Model Form Published Mar 22, 2017
Packet containing forms for many common city positions, each with a list of questions to be completed by a job applicant. Allows city to get more specific job-related information than may be provided by the application itself. A supplemental application works well with a training and experience rating sheet to create qualification-based rankings to identify your interview pool.
EEO Tracking Sheet, LMC Model FormPublished Sep 24, 2018
Worksheet used to evaluate the city’s efforts in reaching all segments of the population in its hiring practices, voluntarily completed by employment applicants.
Instructions for Interview Panel, LMC Model FormPublished Sep 24, 2018
Defines the role of an interview panel participant. Has general guidelines for the panel, steps for the panel facilitator or leader to begin and conclude the interview. Contains a quick list of laws that protect interviewees to guide your questions and a link to a list of questions to avoid.
Job Advertisement, LMC Model FormPublished Sep 24, 2018
Notice of job opening suitable for posting with suggestions on abbreviations to save money if published. Uses example position of a public maintenance worker and can be modified for your position.
Job Description, LMC Model FormPublished Feb 10, 2017
Job description format, using a public works maintenance position as an example. Suggested sections include FLSA status, primary objectives of the position, its essential functions, examples of performance criteria, minimum and desired qualifications, conditions of employment and more.
Job Offer Letter, LMC Model FormPublished Sep 24, 2018
Employers with more than 10 employees are required by Minnesota law to give most employees a written, signed “agreement of hire”. This model puts into letter format all the information that must be included, such as date of the agreement, hire date, rate of pay, hours in a regular work day and more.
Release for Employment Reference Checks, LMC Model FormPublished Feb 10, 2017
Grants permission to the city to investigate any information provided by employment applicants in their Employment Application or any supplemental materials they submit in consideration for an employment position. It releases anyone the city contacts from liability or claims for damage that may result from the investigation.
Telephone Reference Checks, LMC Model FormPublished Sep 24, 2018
Worksheet for city to record information from telephone conversations with a job applicant’s references. Identifies the candidate, suggests possible questions, and provides space to record responses.
Hiring, LMC Model PolicyPublished Jun 9, 2016
Outlines employee recruitment and selection process for a Plan B, Manager form of government city. Includes examinations used, pre-employment medical exams and Equal Employment Opportunity statements.
Employment Exit Questionnaire, LMC Model FormPublished Oct 13, 2017
Find out about an employee’s experience with the city, whether the employee resigns or is terminated. You will understand why employees are leaving with a focus on what is most important to the business needs of the city such as effectiveness of supervision, city policies, promotion opportunities, and pay and benefits.
Community Center Rental Application, LMC Model FormPublished Aug 25, 2017
Gathers information for city to consider a request for use of the city’s community center, such as the date and time of rental, contact information for the individual or organizations involved, estimated attendance and whether food or alcohol will be involved. Establishes an application fee and may require a security deposit.
Community Center Rental Rules and Regulations, LMC Model Form Published Aug 25, 2017
Sets out regulations for use of a city’s community center to a user for an event. Includes provisions on reserving the center, entering into a written agreement, security deposits, rental fees, cancellation or refunds, access to the building, clean up and more.
Skatepark Inspection, LMC Model FormPublished Aug 25, 2017
A checklist for inspecting city skateparks for safety features and maintenance concerns such as loose screws, condition of ramp surfaces, consideration of recent complaints, and more. Documents location of skatepark, date inspected and any action required.
Skatepark Rules, LMC Model FormPublished Aug 25, 2017
Safety rules to post for use of city’s skatepark including required and suggested personal protective equipment, hours, how to report problems, and more.
Sled Hill and Warming House Inspection, LMC Model FormPublished Aug 25, 2017
A checklist for inspecting safety issues on city sledding hills and in warming houses. Documents the location, date, time of the inspection. Notes weather conditions, any maintenance performed, and has space for other comments or notes.
Special Events Information Sheet, LMC FormPublished Aug 25, 2017
Helps cities gather key information on special events to anticipate risks. Collects names and contact data on sponsors, event coordinators, public safety functions and insurance carriers. Should be used together with the Special Events Checklist.
Trail Inspection Sheet, LMC Model FormPublished Aug 25, 2017
Worksheet for logging inspections of city trails. Detailed records of inspections document the city’s reasonable care in maintaining their trails to keep trail users safe. For use with city’s Trail Inspection Policies, which will set inspection intervals and maintenance guidelines.
Standard Resolution Template, LMC Model ResolutionPublished Sep 13, 2018
A resolution is a formal, written expression of a motion used for any action of a temporary, routine or administrative nature. This model provides structure for your content when you are drafting a resolution from scratch.
Proclamation Declaring a Local Emergency, LMC Model FormPublished Nov 28, 2018
Mayor-declared local emergency under Minnesota Statutes chapter 12 on emergency management providing an effective date and invoking the city’s disaster plan. May only be declared for three days without an extension approved by the city council.
RFP Template: Health & Dental InsurancePublished Dec 21, 2004
This RFP template can be used to solicit proposals from insurance carriers for health and dental insurance coverage. This template includes both the basic RFP template, and the specific forms and questionnaires for carriers.
Short Form Right-of-Way Regulation, LMC Model OrdinancePublished Dec 21, 2017
Administers and regulates excavation and obstruction of city roads and streets for smaller cities that may want less extensive right of way management, such as minimal registration and reporting requirements by permit-holders. Still provides for restoration of rights-of-way and city recovery of costs.
Standard Ordinance Template, LMC Model OrdinancePublished Sep 13, 2018
State law requires ordinances to follow a certain form. If you are drafting an ordinance from scratch, this template provides a structure for your content within the features required by state law such as title, an enacting clause, mayor’s signature and clerk attest spaces, and more.
Ad for Sealed Construction Project Bid, LMC Model FormPublished Jun 7, 2017
Published notice for use in soliciting sealed bids on a construction project. Requires security on a percentage of the bid amount and clearly defines bid opening time and place. Provides a successful bidder must be a responsible contractor, as required by state law.
Ad for Sealed Equipment Bid, LMC Model FormPublished Jun 7, 2017
Published notice for use in soliciting sealed bids for supplies, materials or equipment. Requires security on a percentage of the bid amount and clearly defines bid opening time and place.
Waiver of 60-Day Extension Letter, LMC Model FormPublished
Applicants for zoning and other city land use actions may waive the city’s requirement to respond within statutory time frames, and may set another date for action, by providing this type of written notice.
City Administrator Job Advertisement, LMC Model FormPublished Oct 10, 2016
Advertisement of a City Administrator job opening emphasizing attractions of a small city job and city resources to entice qualified applicants to learn more about you and apply for the job.
Memorandum on NFPA Staffing Standards, LMC Model FormPublished Dec 15, 2017
Memo from the city fire chief to the council recommending the city follow different limits than the minimum for fire department response staffing and time as set out in National Fire Protection Association (NFPA) Standard 1710.
Notice of Public Auction, LMC Model FormPublished Nov 28, 2018
Notice of a public auction of personal property or fixtures removed from a property when the city is following procedures under the Minnesota’s hazardous or substandard building laws.
Donation Of Surplus City Equipment, LMC Model PolicyPublished Aug 20, 2018
Establishes ability of the city to donate surplus equipment to a nonprofit organization under state law. Defines important terms. Provides procedural steps and safeguards such as a disclaimer of warranties and a form to be completed by the nonprofit organization to verify compliance with terms of the policy.
Checklist for Hiring City Employees, LMC Model FormPublished Sep 24, 2018
Use this checklist of items you must consider or complete before and during the process of hiring a city employee to ensure compliance with major requirements of state and federal law and to use best hiring practices. Starts with your authority to hire, moves through job description, recordkeeping, job posting process, applications and rating, testing and selection, reference checks and more.
Employment Application, LMC Model FormPublished Sep 24, 2018
Gathers employment applicant information such as education, relevant paid or unpaid experience. Provides applicable data practices notice, optional Equal Employment Opportunity information sheet, non-discrimination statements, and instructions and space to claim veterans’ preference points in hiring. Separate supplemental applications may be used for greater ease in ranking applicants for interview selection.
Personnel Policies Self Audit Checklist, LMC Model FormPublished Dec 3, 2013
Lists items to consider in creating and revising your personnel policies to make sure you have considered a full range of topics. Sets out general guidelines, purpose statements, definitions, Equal Opportunity and Affirmative Action goals, recruitment and selection practices, compensation issues, approaches to holidays and leave, performance evaluation, discipline and more.
Separation from Employment Checklist, LMC Model Form Published Oct 13, 2017
Provides a guide to help supervisors take appropriate steps to prepare for a staff member leaving city employment. Helps the city make sure it receives back all of its property from the employee, address computer and other security issues, complies with all legal notice requirements, and gives the employee any needed information on wages, benefits and insurance.
Playground Inspection, LMC Model FormPublished Aug 25, 2017
Documents inspection of various types of playground equipment such as swings, slides and monkey bars, and playground surface areas. Lists items to look for in each category. Provides space for comments or notes on action to be taken for items showing safety concerns.
Special Events Checklist, LMC Model FormPublished Aug 25, 2017
Helps cities gather key information on special events critical to identifying potential hazards and developing effective controls. For example, helps you consider the types of permit or contract provisions needed, identifies any special hazards to address; helps you plan sanitation needs, disabled access, vehicle issues, emergency planning, and more. Should be used together with the Special Events Information Sheet.
Termination of Veteran Employment Letter, LMC Model FormPublished Nov 17, 2017
Letter notifying a veteran of a demotion or termination of employment. Contains statutorily required provisions for hearings, time frame for response, and has paragraphs to customize notice for union, non-union, and civil service employees.
Extending 60-Day Time Period Letter, LMC Model FormPublished Jul 6, 2017
Gives notice to those requesting zoning and other city land use actions that city will take an additional 60 days to consider their application. Includes information required by state statute.
Restarting 60 Day Timeclock Letter, LMC Model FormPublished
Gives notice to those requesting zoning and other city land use actions that their application is missing required information. Informs applicants that until all required information is received processing will not begin, nor will the state-required response period of 60-days start to run.
City Manager or Administrator Training and Experience, LMC Model Rating Sheet FormPublished Oct 10, 2016
A worksheet used to evaluate and score applications for a city manager or city administrator position. It takes into account minimum requirements, desirable qualifications, experience and knowledge in certain municipal practices, and provides required addition of scoring points under Minnesota’s veterans’ preference laws.
Job Applicant No Hire – No Interview Letter, LMC Model FormPublished Nov 17, 2017
Notifies veterans and other job applicants who will not be granted an interview, or who were interviewed but not hired. Contains alternative provisions to help you customize the response based on the reason for your decision, such as not meeting minimum requirements, or qualified candidates in a pool with other candidates that more closely match the city’s needs.
Waiver for Physical Ability Testing, LMC Model FormPublished Aug 17, 2016
Injuries during a test of a job applicant’s physical abilities are not covered by workers’ compensation insurance. If your city uses physical ability testing when filling a position, consider using a waiver like this to inform applicants of risks and protect the city from liability for injuries.
Affidavit of Official Interest in Claim, LMC Model FormPublished Nov 19, 2018
A formal statement made by a city officer required when the city contracts with the officer and competitive bidding is not required. Makes the declarations required by state law, such as affirming the contract price was as low, or lower than other sources. This sworn statement must be filed with the city clerk before the claim is paid.
Overtime Pay or Compensatory Time Election, LMC Model FormPublished Oct 11, 2018
Allows an employee to make an election for compensatory time in lieu of overtime for the calendar year prior to the year in which overtime hours may be accrued. Such an election may avoid income taxation under the IRS doctrine of Constructive Receipt.
Layoff Notice Letter, LMC Model FormPublished Nov 17, 2017
Letter notifying an employee of a layoff. Sets out information on severance pay, unemployment insurance, benefits continuation, PERA options and Employee Assistance Programs. Provides veterans’ preference protection information to employees whose veteran status has not previously been verified by the city.