Loading...
HomeMy WebLinkAbout15-0791, � t — -dry 9,msip �� y�®rm,■ CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. 1 _ d -1 Q (©ffice Use Only) APPLICATION FOR TAXICAB / 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 Firstff Middle i ( Last 1. Name (REQUIRED) \FsI()G,- R�+ G( -50n 2. Address (REQUIRED) 3. Contact Information (REQUIRED) Email: sent via email) 4a. Chauffeur's License expiration date (REQUIRED) LAA /:)-o I K b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: OJot-LQ rS for L111� A DL-ZtS�lo til,(' aA� v4f,a LOOrtLoA RV- V,9_Ytt3t)Si f��m(al�J t�IiPE ;1SQ WDEXPA Gi0 _ t�%p rn Q 0 &-c e— 46. Have Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where Convicted Dismissed Deferred Suspended Plead Guilty 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five Tvpe of offense Where When 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please prd& the�me(s) 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) 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that 1 have issued to me by the Iowa Departm nt of Transportation a v lid Chauffeur's license number S S XX (CI �(� issued on expiring on I understand that if I falsely answer any questions in this application, that this app icati n may 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 authorization to be a taxicab driver is granted, to comply at all times with all of the provisiors�of­Tjte 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date L4 — 1 I STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and swom to before me by _TT 5 f r• H Ol ng,L�, on this 1—ALT day of I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code)._ Expiration date of Chauffe 's I' en gnature of Police Chief or desi e Z0/ 8 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. ra b A Signat e of City Clerk or designee a r t+ rn Office Use Only R' Approved application DCI report State certified driving record Website update aerW MIDRINBMGEAPPLM014.,,.nded.00c 03/2015 4.C41UVVAD0T Ski I SIMPLER U5T4MEA DRIVE+d vVww,i0V1li3t�Ci�.�t3V Office of Driver Services FP Bax 9204 ; Des Moines. IA 50306-92D4 ?hone: 515-244-9124180(1-532-11211 Fast: 515-239-1337 vrvrw.Nsvradot_gov Certified Abstract of Driving Record Inquiry Date: 3/31/2015 DL/ID 9: 555XX3960(IA) Name: Olson, ]eslca Holli Class: D Address: 19011/2 -BROADWAY ST APT Audit#: 6BS7422 Restriction None Issue Date: 04/12/2013 City/State: IOWA CITY, IA 52240 Expiration Date: 04/08/2018 Endorsements: 3 Mailing Address: 19011/2 BROADWAY ST APT 8 Restrictions: NONE Date of Birth: 4/8/1985 Mailing City/State: IOWA CITY, IA 52240 Sex: F History Information CLEAR DRIVING RECORD Name: Olson, ]esica Holli DL/ID: 555XXI960 Customer 9: 3041918 ID Status: EXP DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: 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 autnorlaed 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: •: F 9y 3/31/2015 IOWA' D. 0. 1...: f _ Office of DrNer Services n1 QR?�o= Iowa Department of Transportation Name: Olson, ]esica Holli DL/ID: 555XX1960 Apr, 1. 20 15. 9:35AM Div of Crlmloa) Inv estigatloo No, 3912 P. 4/4 IYIar.,Jl. [V19 IV;40AIVI Llry Werx - Glly of Iowa City No. 5114 P. 2 To: Iowa bivislon ofCrlminal Investigation Support Operations Soregu, lel Floor 215 E. 7'h Street iDea Molues, Iowa $0319 (013) 77,5-6066 (SM 725.6000 Fax I am reouostin¢ an Iowa Oilainal Htstory Record Check mr. DCIAccounMinrbm Dov, -F-- (Itappllcable) From: _ City of Iowa City City Clerles Oftloe 410 E. Washington Street Iowa Cloy, IA $2240 Phone: 319-356-5041 Fox; 319-356-5497 Last NaMe mandawy) First Flame maodalo,y) Middle Nome recommended) c7 I �o n ..je5i (La, Oo i i, Date of Firth (mandatory) Gender (nlradero) Social Secari Number (tecommnade� ori/�a/res ®141aIe L`'(Female L4 -�a - �3a l wtiiverIVOPMaiion. Without a signed waiver from the subJect of tho reguest, a complete criminal hbtory record may not hereleasablo, per Code of Iowa, Chapter 6921. For,covoole criminal history record Information, as allowed bylaw, always obtain a walver signature from the sob ect of the re ues t. Waiver Relerxse: lbeaeby givo pnmisalon for lho above requOing ofllolal to wnduet en lova crrmhpl hialoryrcoord cbeekwith Tho DMaion oferinlinal lnvuligallon (DCI). Myrrlminal hisiorydun wnamb)g -main by the DO maybe released a9 allowed by `lmv.\\ Waiversigfzafure: (DCI Wo oaly) As of 5 a search of the provided ruche and date of birth revealed; No Jowa Criminal History Record found with D CT ® Iowa Criminal AstoryRecord attached, DCI # DCIJaitials_ a Received Time'7Mar, 31.x;2015 10MAM No. 3806