The URL can be used to link to this page

Home My WebLink About14-259Authorization Number !q -- 11 'Fl (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.) 410 East Washington Street Iowa City, Iowa 52240-1826 Eallearo $® cm"volete$/re'2egqu-ne "infarms don will res Ifit in don ®al11callon (319) 356-5040 (319) 356-5497 FAX First Middle f Last y') 1. Name (REQUIRED) f 2. Mailing ddress a. ConiactAlnformasonE (REQUIRED) Email: �'r,r l ') Ji cell Phone: ( 1, 4. Prior experience in transportation of passengers: 6. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? i t° Type of offense Where When 6. Have youcid of operating a motor vehicle while under the influence of alcohol or drugs in the last five t years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? Al Type of offense Where When 9. Have youewer applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED,` DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEyJ(' You must apply for an Individual Department of Criminal Investigation Report (form avallabie"ut5dn rd�"gLtest) (OVER FOR REQUIRED SIGNATURE AND NOTARY) �'"' 09/2014 l hereb certi that I have issued to me by the lova Department of Transportation a valid Chauffeur's license number e _3 . I understand that if I falsely ansvier 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 of Title 5, Chapter 2, of the City Code. (Meads to Ise slgaed in front of a Notary Public) _ Signature of Applicant �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 lcgov.org. STATE OF IOWACOUNTYOFJOHNS) / S b d a ndwom to beforo a tme by I>"d a d) y� r ` On this b =� lk day of _.._.___ ......,, ....... ---- .,--------- _. Notary Public in and for the State of Iowa 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). Signatuf o oliTef or designee 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 8 W (width) and 5'/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update ClaWAXIDRNBADGEAPPL92C'4emendW.DOC 09/2014 ;. Dec. 2. 2014012._13PM Div of Criminal lovestigat=on ACI IORNa.3319 P. 1/2 npe STATE OF IOWA .. Criminal atory Record Check�a Request Form y h 1 Amount NumbPr. FCFmm- - M 10 a CAMi 1 cc�r rmN As of a wmvh of dia providod mom and date of blab m wr alcd: 13 No ims criounni Hist uu with Da Iowa Cdondnalfai ry Rrwdaftwh tl 6— -90 DCI lnitlals ,.t, Received Time Dec, 1. 2014 1:46PM No -6234 Dec. 2. 2014 12:13PM Div of Criminal Investigat on No.5319 P. 2/2 GZROr,9T9V_wft ALAN rNIOB SEX RAC 1 ADDITIONAL IDLNTIFIBRS 01 ARRESTED 20030912 MGT NOT EYE HAIR SEN 506 200 BRO GRY CCN RECORD "&* N AGENCY: IAD52020D IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-2(2) EFT 2BD dC#e 100953201. COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO— 01 IA STATUTE IA714.2(2) THEFT 2NO DEGREE 1970 COURT CA59 117: 06521 PECRO66430 CHARUECLASS; NDN CONVICTION TRX#z 100953201 RESTITUTION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20040709 PROBATION 3Y 20040709 DxsCah,RGxO FROM 20121.207 DEFERRED JUDGEMENT WITHOUTAN ARREST DISPOSITION 19 H♦ 'A f OF GUILT. THIS RECORD MAINTAINED By THE IOWADIVISION OF CRIMINAL IMVSSTIGATION, BUREAU IDENTIFICATION 19 A PUBLIC M"t B07 CAN ONLY BE RELEASED TO MON-LAW ENFORCEMENT AGENCIES BY THE vCi. IN THE ABSENCE OF FINGERV11XNTS FOR POSITIVE IDENTIFICATION THIS RECORD 15 BASED -ON INFORMATION FURNISH=. WE CANNOT CONFIRM OR DENY THAT THE RECORD 4 L. DIVISION OF CRIMINAg. INVESTIGATION ofi`PO WAR 92014, Dies Iftnes, 1A, WOW 6AA 5,1152441mighl CertliilYlil d Abstract of IlDrml ing IRecord Inquiry Datm 12/2/2014 DL/ID #: 959ZZ3004(IA) Customer #2 1549690 Name: Gerot, Steven Alan Class: A ID Status: None Address: 2254 S RIVERSIDE Audit #: 7647396 DL Status: VAL DR TRLR 42 Name: Gerot, Steven Alan DL/ID: 959ZZ3004 CDL Statusz VAL CDL Cart Status: Non -Excepted Intrastate CDL Med Statum None Restriction None Supplement: Pursuant to Iowa Code §321.10, 1, 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 theseal' of the Department to be set upon this document, at Ankeny, Iowa this date: 12/2/2014 Nkame: Gerot, Steven Alan IDIL/IIID: 959ZZ3004 Office of Driver Services Iowa Department of Transporation Issue Date: 12/27/2013 City/State: IOWA CITY, IA Elaelpttratioon IDato: 09/22/2018 52246585 b IEndorsamentm LNT Mailing Addra.s: 2254 S RIVERSIDE Restrictions: NONE DR TRLR 42 Date of Birth: 9/22/1957 Mailing IOWA CITY, IA Sex: M City/State: 522465850 History TinfDlflffta't(IDII1 Name: Gerot, Steven Alan DL/ID: 959ZZ3004 CDL Statusz VAL CDL Cart Status: Non -Excepted Intrastate CDL Med Statum None Restriction None Supplement: Pursuant to Iowa Code §321.10, 1, 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 theseal' of the Department to be set upon this document, at Ankeny, Iowa this date: 12/2/2014 Nkame: Gerot, Steven Alan IDIL/IIID: 959ZZ3004 Office of Driver Services Iowa Department of Transporation