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Home My WebLink About15-042 IDENTIFICATION NO. / - — 1 (Office Use Only) ��— APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday—Friday) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX First,d Middle Last p 1. Name(REQUIRED) 2. Address (REQUIRED) .303l 17 lad/ rZ iv 3. Contact Information (REQUIRED) Emai: ��C�qG� /J/!'1Ai/ Cele Cell Phone: ,573—S7/-o9�'� (All Written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) P--9"1/401 F�S b. Taxicab Business Name(REQUIRED) Aholit t nAktom' G:' 5. Prior experience in transportation of passengers: 1, g^ 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or.elsewhere? !►� Type of offense Where When :__) What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested/charged with any traffic offenses in the last five years? 11/0 Type of offense Where When What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other N//9-,,/� 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 4! Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) /r4 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify Oat I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 01A ,7y.8q issued on ;�;2b-)-01'1expiring on „2- a0/9 . I understand that if falsely answer any questions in this application, that this application may be denied. I agree that in making this application, 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 authorization to be a taxicab driver is granted,to comply at all times with all of the provisions of Title 5,�C,hapter 2, of the City Code. (Needs to be signed in front of a Notary Public) l✓ Signature of Applicant ✓ s6 4( Date 0,2 3 7-,o20/5 ************************************************************************************************************************************************ STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by 1<.e, tt. cr0 on this a`7-t.�j, day of _13.eloirt_c , y WEND tI!�' j 28 C-0 Notary Public for the St of to vgairokiii ******* ********************************************************************************************************************************* 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). 211)//-5 Signature • '. ceChief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. THE EFFECTIVE DATE WILL MATCH THE CHAUFFEUR'S LICENSE EXPIRATION IF LESS THAN A YEAR. 71/k-,z 74g Signatt of City Clerk or designee ate c..F'y Office Use Only _ , Approved application DCI report State certified driving record Website update Clerk/TAXIDRIVBADGEAPPL92014amended.DOC 02/2015 • T vvvvvv, owadot.go SMARTER 1 SIMPLER ! CUSTOMER DRI a v. ..,... Office of Driver Services PO Box 9204!Des Moines,IA 50306-92E14 Phone:515-244-9124}800-532-1121 I Fax:515-239-1837 v,sww_i:owdot.gov Certified Abstract of Driving Record Inquiry Date: 2/13/2015 DL/ID#: 013SS7989 (IA) Customer#: 1112851 Name: Crawford, Keith Heriuff Class: D ID Status: None Address: 120 SPRUCE ST Audit#: 7827466 DL Status: VAL Issue Date: 02/26/2014 CDL Status: None City/State: WILTON, IA 527789707 Expiration Date: 02/24/2019 CDL Cert Status: None Endorsements: 2L CDL Med Status: None Mailing Address: 702 W FULLIAM AVE Restrictions: NONE Restriction None Date of Birth: 2/24/1982 Supplement: Mailing City/State: MUSCATINE, IA 527613033 Sex: M History Information CLEAR DRIVING RECORD Name: Crawford, Keith Heriuff DL/ID: 013SS7989 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: q4 ,.....,.. .9•N 2/13/2015 IOWA•* to 90(1400 W: ° iI"*.c7,- Office of Driver 1 rvices Iowa Department eof Transportation Name: Crawford, Keith Heriuff DL/ID: 013SS7989 Feb. 13. 2015 11:30AM City Clerk — City of Iowa City x+0. 5629 P. 2 STATE OF IOWA / Criminal History Recojd Check Request Form ''�i\�\•I `y':1 DCI Account Nwnber: 4 bp?.—F (itappflcAlc) To: Iowa Division of Criminal Investigation From: City of Iowa City Support Operations Bureau,Lit Piper City Clerk's Office 215 E.7t1h Street 410 I,Washington Street Des Moines,Iowa 50319 (515)125-6066 Iowa City, IA. 52240 (515)725-6460 Fax Phone: 319-356-504/ Far: 319-3564497 Z ain requesting an Tower Criminal History Record Cheek on: Last Name(mandatory) First Name(nI ia!nry) Middle Name(recommended) - bo eay.a . ddif lT Date of Birth(mndaaory) Gender(mandatory) Social SeeurityNumber(recommended) 42/21'J 9 /� &2 — 1211Y ale Liremale120'/3/2,09,5 Waives I>nformatiOn:Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692,1 For complete criminal history record infoirmat(ou,as allowed by Paw,always obtain a waiver*labor efrom the subject of the request. Waiver Release:11ereby give permission for t e above requesting official to conduct an Iowa criminal history record articular the Division ofCYiminar investigation(DCI), Any criminal history dais concerning me that is maintaina4 b Jiro may be released as allowed by law. m WaiverSignature: ,�i !A/ _ • d L1 T Iowa Criminal History Record Check Results (DM usc.oniq) As of ay/to pc ,a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCI _- - l I TAvon rrim;nal XYi.etnw Rerrwri at e+Ad.