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Home My WebLink About15-026� r CITY OF IOWA CITY 410 East Washington Street loi a City, Iowa 52 240-1 826 (319) 356-504 (319) 356-5497 FAX 1. Name (REQUIRED) Authorization Number / 6- -�L Jej (Office Use Only) APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Failure to complete the "required" information will result in denial of the application First Middle 2. Mailing Address (REQUIRED) 3. Contact Information (REQUIRED) Email:St��r��h ptI fx[yQ�ell Phone:q�� Y) 1-0�iriFj 4. Prior experience in transportatiopf passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? IAM , Type of offense Where When 6. Have y9q been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?`Q Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When w 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five yeas Tvpe of offense Where 9. HaCD ve you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide t w9"name( \ic) j DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report (form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) 09/2014 I hereby certi that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number q'Ijl?�5 I understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will be denied. I agree that in making this application, I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to examine any and all records and documents relating to this application, and I further agree that, if a license is granted, to comply at all times with all of the provisions Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Q � � ,- /j Signature of Applicant Date �0 -Off- YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by On this day of Notary Public in a d for the Statof Iowa S mission Number 729428 o _ My Commission Expues 7_1 — k*kkkiiih#ii###i;#h##*;t;;#*tiff**#*i***fi*fikfififik#4k*fihh#*fi#k#### I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). Signatu of Pe�lthlef Crdesignee a-/-/- /s Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 5 %" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update ClerWrAXIDRMADGEAPPL92014ar erded.OGC 0912014 Oct. 8. 2014 11:06AM� Div of Criminal Investigation .•ISI. u. cult nr );4uVIlp 1,1erK blty ol. Iowa 1,11y STATE OF IOWA ( III11 & HistoryRecoled Check -i\ Request Formi ��414[il• �� To: Iowa Division of Criminal Investigation Support Oppratlolls r)ureau, l" Floor 215" R Tb Street Des Maine&, Iowa 50319 (515) 725.6066 (515)125-6000 tax No.Ivy.hiiv N Z ,DCI Account Numbet; _ 4 nn.2-F of applicable) .From: CltvofXowacity Clfy Clerlc'e office 410 It. Woshhlgton Street lows CI IA 52240 Fhono; 319-396.5041 Fax: 319-3'-9497 IowaCriminalHistory Record Check Results tnci �eanty) As of �� d �� a search of the provided name and date of birth revealed; I 0 No Iowa Criminal Ilistov Record found with DCT Iowa Climinal Rlstorq Record attached, DCI #� w DCI Received TimerOcl,._6._02014 3:45PM No. 1383 Oct. B. 2014 11:06AM Div of Criminal Investigation No.1416 P. 4 DCI;00946568 NAME: SING,SBNA LEE DOB SEK RAC 19830815 F A ADDITIONAL IDENTIFURS TAT HAND TAT R LEG TAT UL ARM TAT UR ARM 01 ARR99TED 20111226 IOWA CRIMINAL HISTORY DCI 00946568 MISDEMEANOR CONVICTIONS ONLY PAGE I OF 1 DATE PRINTED - 2014/10/08 HOT WGT EYE HAIR SKN POB 502 180 BRO BLK FAR IA PHOTO AVAILABLE: Y CCH RECORD **• AGENCY: IA0770300 DES MOINES PD CHARGE NO- 02 IA STATUTE IA708.2A(2)(A) DOMESTIC ABUSE ASSAULT TRK#+ 7B000U502 COURT DISPOSITION AGENCY: IA0770151T POLK CO DIST COURT COUNT NO- 01 IA STATUTE IA123.46 CONSUMPTION / INTOXICATION - 1978 COURT CASE ID: 05791 SMAC325867 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 7B00QU502 SENTENCE DISP EFF DAT TIME SERVED 4D 20120424 JAIL 4D 20120424 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION Iowa [department of Transportation Once of Urrve;r `cervices (Tall Roe) l3iltf h32 1121 tL PO law 9204, UBS Manes, IN 503UO 9204 51` 2.44-9124 FAX 239 183E Mailing City/State: Convictions Date of Birth: 8/15/1983 WEST LIBERTY, IA Sex: F 527761201 History Information Citation Date Conviction Date Certified Abstract of Driving Record I Explanation Inquiry Date: 10/2/2014 DL/ID #: 975AA8135 (IA) Customer #: 4071375 Name: Sing, Sena Lee Class: C ID Status: None Address: 105 E 6TH ST Audit #: 8496591 DL Status: VAL Issue Date: 10/02/2014 CDL Status: None City/State: WEST LIBERTY, IA Expiration Date: 08/15/2019 CDL Cert Status: None 527761201 Endorsements: NONE CDL Med Status: None Mailing Address: 105 E 6TH ST Restrictions: NONE Restriction None Supplement: Mailing City/State: Convictions Date of Birth: 8/15/1983 WEST LIBERTY, IA Sex: F 527761201 History Information Citation Date Conviction Date ACD I Explanation County ]UR 06/12/2011 07/12/2011 M14 Fall to Obey Traffic Si n/Signal Polk IA Sanctions Type Effective End ACD Explanation Occurrence ]UR ]UR Suspended 11/01/2011 02/10/2012 D53 Non -Payment of IA IA Iowa Fine Name: Sing, Sena Lee DL/ID: 975AA8135 Pursuant to Iowa Code 4321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this Is a true and accurate copy of an official record currently In the custody of said Office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify. In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: // 'li 10/2/2014 +x• i��V Office of Driver Services Iowa Department of Transporatlon Name: Sing, Sena Lee DL/ID: 975AA8135 i Iowa Department of Transportation erg Olhce of Clftvef :service, 1 toll F ree) 1f1)fy Q2-1 $21 'd1 PO 80x'13204, [Xs Moin0s, I.A 503WU204 515-244-9124 1_IV' til`, 239.1831 Mailing City/State: Convictions Date of Birth: 8/15/1983 WEST LIBERTY, IA Sex: F 527761201 History Information Citation Date Conviction Date Certified Abstract of Driving Record Ex lavation Inquiry Date: 10/2/2014 DL/ID #: 975AA8135(IA) Customer #: 4071375 Name: Sing, Sena Lee Class: C ID Status: None Address: 105 E 6TH ST Audit #: 8496591 OL Status: VAL Issue Date: 10/02/2014 CDL Status: None City/State: WEST LIBERTY, IA Expiration Date: 08/15/2019 CDL Cert Status: None 527761201 Endorsements: NONE CDL Med Status: None Mailing Address: 105 E 6TH ST Restrictions: NONE Restriction None Supplement: Mailing City/State: Convictions Date of Birth: 8/15/1983 WEST LIBERTY, IA Sex: F 527761201 History Information Citation Date Conviction Date ACD Ex lavation County JUR 06/12/2011 07/12/2011 M14 Fall to Obey Traffic Si n/Si nal Polk IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 11/01/2011 02/10/2012 D53 Non -Payment of IA IA Iowa Fine Name: Sing, Sena Lee DL/ID: 975AA8135 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is a true and accurate copy of an official record currently In the custody of said Office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify. In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: ........ 10/2/2014 1C3U11A .��,s DF b8�4{A'a°� Office of Driver Services Iowa Department of Transporation Name: Sing, Sena Lee DL/ID: 975AA813S