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Home My WebLink About15-098� l 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 13191 356-5040 (3191 356-5497 FAX IDENTIFICATION NO. / C _ ff (Office 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 FirstM''La t. 1. Name(REQUIRED) S� r; � <F' 9 01 Address (REQUIRED) �%\ �k--Jj �j �-CJ-�- r Contact Information (REQUIRED) Email: ilrlci�tM�Ayt'rJ J yn+a t .Ginn Cell Phone: (Ali written cotm�munication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) `33 Y a p-7 b. Taxicab Business Name (REQUIRED) _� 5. Prior experience in transportation of passengers. ` A ci� Ir i," �Y KY rv,,ti, 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? Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where _ When N r a w7 7 a (,� Mi-toNv 19-! 1-- �✓�3 b o tiros n 9. Have you ever a�pred to be Iowa City taxi driver using a different name? If yes, please t ame(j`] DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STA RWED M DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE F REVIEW—, You must apply for an individual Department of Criminal Investigation Report (form available t(Pn request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) C2/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereb c t at I v issued to me by the Iowa Dep rt ent of Transportati va chauffeur's license number S"II 0 _ �V issued on � U S L expiring on �� ' J ! . I understand that if I falsely answer any questions in this application, that this appli ation 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 provisions f T' e 5, Chapter 2, of the City Code. (Needs to be signed/in front of a Notary Public) Signature of Applicant Date I STATE OF IOWA ) COUNTYOFJOHNSON ) and swcrq to before me by �= C rc ., �E K_'e—1 0"_ on this % day of in an f)for the State of Iowa 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 Chauff u ' license I 0 f Sig ature of Police Chief or designde 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. tlt ux-� 2 . `� t� Signatrdeof City Clerk designee Approved application DCI report State certified driving record Website update ,5117 111s Date N O �s2 3 a _;< Office Use Only ��/, c tr ClerkjTN 113RNBADGEAPPL92014ame ded.DCC 03/2015 Apr -28- 2015 11:07AM Div of Criminal Investigation 04itiimu a u:0/rei iow Cab or Iowa uiry STATE OF IOWA 4) Criminal History Record Check Request Form To., Iowa Division of Criminal Investigation Support Operations Bureau, l" Floor 215 R, 71" Streat Des Molaed, IOWA 50319 (515)725.6066 (515)725-6080 Fax No. 5971 P. 2/2 (FAX)31933Qtuo r uu2/002 ACI Account Number: _9967-F drapplicable) Front _ 'Yellow Cab of Iowa MY Box, 42@ Iowa City, LL 52244 (319) 338-9777 , ' Phone! Fax: (319)339-7302 -- -- --------- Last Name (mondaly First Name (mandatory)' Riddle Name (rewo%Ended Date of Birth (mandem Gender mandao Social Secu rity Number rccdmramdad Wafver V011"Maflos: Without a signed waiver from the subject of the requcet, a complete erlminal history record may not be releasable, per Code of Iowa, chapter 692,2. For coin plato crlmIna I hlstory-record'Information, as allowed by law, always obtain a waiver signal ore from the suh cot of the re nest. Waiver Release! I hueby give permission fbr the abovilXqUOSUP8 oa1Cle) to 00114401 an Iowa criminal history record cheekwllh the Division df Cominei rnvenlsmlon (DeD. Any orlminel bletnry data cones min8 m al Ir nldned by lhC DC[ may be released u allowed by law. Waiver Signature: ,Iowa Criminal History Record Check Results (DCT use only) �� As of ` 0—i—i5 a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with ACI Iows Criminal History Record attached, DCI CD ACI Initials DCT -77 (08/25/10) Received Time Aor.27, 2015 3:11RM No. 643A Iowa Department of Transportation (vh e of urro f `..iOrr iTes i 1011 1 rc' e) 801 H i? 11-11 !-[ f;n'. 'U'04, UC'S MOtYti A. i1iY45 J20 b14--244 ' S1 211'f1i51F33 131f Certified Abstract of Driving Record Inquiry Date: 4/27/2015 DL/ID # Name: Nealon, Sean Class: Francis Address: 2401 HIGHWAY 6 E Audit #: APT 3416 Convictions 433YY0367 (IA) Customer #: D ID Status: 6441766 11/03/2012 10/30/2017 3 Corrective Lenses 10/30/1969 M History Information DL Status: CDL Status: CDL Cert Status: CDL Med Status: Restriction Supplement: 980244 None VAL None None None None Citation Date Conviction Date Issue Date: City/State: IOWA CITY, IA Expiration Date: 07/27/2010 522406788 S92 Seed Endorsements: Mailing Address: 2401 HIGHWAY 6 E Restrictions: APT 3416 05/12/2011 05/16/2011 Date of Birth: Mailing IOWA CITY, IA Sex: City/State: 522406788 Convictions 433YY0367 (IA) Customer #: D ID Status: 6441766 11/03/2012 10/30/2017 3 Corrective Lenses 10/30/1969 M History Information DL Status: CDL Status: CDL Cert Status: CDL Med Status: Restriction Supplement: 980244 None VAL None None None None Citation Date Conviction Date ACD Explanation County JUR 07/27/2010 08/12/2010 S92 Seed MO 05/12/2011 05/16/2011 S92 Speed (10 mph & Johnson IA under in 35-55 mph zone 03/04/2012 03/12/2012 M14 Fail to Obey Traffic Johnson IA Si n/Si nal 04/09/2013 04/12/2013 M14 Fail to Obey Traffic Johnson IA Sign/Signal 06/22/2014 06/26/2014 MOS Fail to Obey Officer Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number IUR 09/05/2014 815689 IA Name: Nealon, Sean Francis DL/ID: 433YY0367 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: 4/27/2015 4� IOWA .$�D. 0. T .= t'•" t k,'i lxxxw.3..r»--¢ office of Driver services Iowa Department of Transporation Name: Nealon, Sean Francis Dl/ID: 433YY0367