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Home My WebLink About15-009, F Ye, (6Crub II pe Ist CITY OF IOWA CITY 410 East Washington Street S t lotva 52240-1826 -SO40 f o.r/ice56-5497 FAX Authorization Number cm (Office Use Only) APPLICATION FOR TAXI / MOTORIZED PEDICAS VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday -- Friday.) Faiduae to cavafa �pla tha "a raaratt°' ervt'oeamatiort„bVfu rmsult fn [tenial of the ro-pfa9cg�'(aean First Middle Las( 1. Name (REQUIRED) Kvwii zw's 2. Mailing Address (REQUIRED) 14 mec” :.L ) 3. Contact Information(REQUIRED) Email: Cell Phone: -7n2-,%42-8143 4. Prior experience in transportation of passengers: m.�v 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? -'11 Where N= 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? tw1w MM 7. Have you been convicted of any traffic offenses in the last five years? Mcl Where MM When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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'f 6me(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CSR rIF �wp DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CH 11 , You must apply for an individual Department of Criminal Investigation Report (form available upon'request)., (OVER FOR REQUIRED SIGNATURE AND NOTARY) CA 09/2014 hereby certify that II have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number I understand that if I falsely answer any questions in this application, that this application may be denied. i understand that if 1 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 lova 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 of Title 5, Chapter 2, of the City Code. (Needs to be slgnad In frcat of a Notary Public) Signature of Applicant " °"' ""'" Date VI PAS" 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. h**x****:k*R*k,k*#*##*##**'k3***********#**R#***n*******:M**HtRhM*********4k*##tl•t***'k*******t.**MN*****#***********************t#**R******##**d* STATE OF IOWA ) COUNTY OF JOHNSON ) ,Subscribed and sworn to before me byit/a On this day of •r ;d 1. ... ..� w.�--+ '' �';~, - 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). Signature o Poli designee :>7 7r 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. Sig nature of City Clerk or designee . /',-� - 4, a Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 5'/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update Clerk/rAXIDRNBADGEAPPL92014ameMedDOC 09/2014 Name: Dofner, Kenneth Brian Robert DL/ID: 8.53ZZ0129 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: µ� Ni 1/6/2015 �w �ema��am �I�I Ia ° U Daq@ pp��.� �IaM'�u ®R` w„'''w�� 'p twos.. Office of Driver Services sus Iowa Department of Transporation Name: Dofner, Kenneth Brian Robert DL/ID: 853ZZ0129 'Iowa DepartmentofTransportatioll Go'ce IRA FIT10000,a32,1112 xbA=RM. i 18%MOA IA 50,30 „$AW i 55244-9'1214 i'AX A623C l rO Certified Abstract of Driving Record Inquiry Date: 1/6/2015 DL/ID #: 853ZZ0129 (IA) Customer #: 2516298 Name: Dofner, Kenneth Class: C 10 Status: None Brian Robert Address: 214 DRYDEN AVE Audit #: 7635520 DL Status: VAL Issue Dates 12/24/2013 CDL Status: None Clty/States MC CLELLAND, IA Expiration Date: 09/02/2018 CDL Cert tus: None 515483006 Endorsements: I CDL Med Status: None Mailing Address: PO BOX 44 Restrictions: NONE Restriction None Supplements Date of Birth: 9/2/1985 Mailing WEST BRANCH, IA Sex: M City/State: 523580044 History Information Name: Dofner, Kenneth Brian Robert DL/ID: 8.53ZZ0129 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: µ� Ni 1/6/2015 �w �ema��am �I�I Ia ° U Daq@ pp��.� �IaM'�u ®R` w„'''w�� 'p twos.. Office of Driver Services sus Iowa Department of Transporation Name: Dofner, Kenneth Brian Robert DL/ID: 853ZZ0129 Jan. 8, 2015 9:19AM Jura 1. 1015 9:29AM Div of Criminal Investigation City Clerk - City of Iowa City STATE OF ROW.A Critipi incl History Recoyd Check Request Form TOE XQWA nDiVISIOn of Cr�aot'aaU.:bav" liaallan B uIppo t ()Iporaflant Th ream,, V.MoDr �A� bNd 7"� �tu'eat Doi MDORoss,Iowa gc.:@9 (815) 7746®66 (518) 7294080 Fax DC1 Account Ntunb or: MY Clark's Offies No. 7538 P. 1/1 No. 5516 V. I/I AM 2 .52240 rbxam ,319-396-9041�__________________----..- lam 29.31(li 7 -_______________w___________..___________ _____M_____________ _, _________. owa Crim:inal. lbstor .corde.k, Ras � � ( ,�000►�, is Of a search of the provided name and dato of birth revealed; ; o Iowa Crlminal toi Record found with W1 Iowa Criminal History Record affached.„ DCT Received Time—J ,„ 2015' 9:250—No. 821