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HomeMy WebLinkAbout15-132IDENTIFICATION NO. /5-- J t (Office Use Only) APPLICATION FOR TAXICAB 1 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 (3 19) 356-5040 1319) 356-5497 FAX Irst Middle Last 1. Name (REQUIRED) t i(_. 2 Address (REQUIRED) 191'a HahinavN To Ct: Zck"K Crr 3. Contact Information (REQUIRED) Email: ZtyCv�e�5e,1�S 7b� VOLVC.(-E' 1 Cell Phone: (3►a 530-8116 (All written communication (sent via email) 4a. Chauffeur's License expiration date (REQUIRED) G/ Je/ 1 -7 b. Taxicab Business Name (REQUIRED) _ / v Ar(c 5 A6(et10 5. Prior experience in transportation of passengers: CAA:) A� J(? t- k,/\ ._L)wn C :% Ia. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Y25 Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other V. Have you been arrested / charged with any traffic offenses in the last five years? JL5 Type of offense Where When P056 ek AjShJccm j MAC; &'\C,- 1ovjc; C,, R A9 %, What happened to the charge? (Circle one) Convicted Dismissed eferre Suspended Plead Guilty Other . I 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 1 V C) Type of offense Where When ti 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pr ¢i� thenameS(S)) y DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STAT�FIE TID DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE Pdgf VIE You must apply for an individual Department of Criminal Investigation Report (form available upVin req&At). C (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) Co 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa De m nt of Transportation a va id Chauffeur's license number Efn ��R issued ony la expiring on ( t-7 I understand that if falsely answer any questions in this application, that this application 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 of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant fes_ JLA_U I I Date b JR (5— STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by � ri r A 2 15e on this 2\-< day of !fu.._.e 1u I � . _ , MAYER q Notary Public in andQbr the State of MY 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 Chauffeur's license oce jv`-� 2c D t% , � k�z_ ()Co24j fJ Signatu e of Pol ce Chief 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. X . ignalure of City Clerk or designe ®l!/G/is Dat Office Use Only N Approved application c Y� DCI report -- State certified driving record Website update Cf N Co CID Clerkl MDRIV9ADGEAPPL92014.... d.tlDOC 03/2015 C SiAARTtR I S1PAPLI[ I (USOM-'-I- brr!iVf N 4 ltl:/'tri1.iowad )tgov Inquiry Date: 6/26/2015 Name: Nelson, Eric Vernon Address: 1912 HANNAH JO CT City/State: IOWA CITY, IA 522403080 Mailing Address: 1912 HANNAH JO CT Mailing City/State: IOWA CITY, IA 522403080 Convictions Office of Driver ser✓icss FO Box Q204: Des Marines, IA £A306-5204 Phone: 515-244-9124.1 8013-532-1121 1 Fax: 515-239-1837 wWw.KlYJad gav Certified Abstract of Driving Record DL/ID #: 464KK6798 (IA) Customer #: 2301096 Class: D ID Status: None Audit #: 6011555 DL Status: VAL Issue Date: 05/29/2012 CDL Status: None Expiration Date: 06/05/2017 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Restrictions: NONE Restriction None Date of Birth: 6/5/1976 Supplement: Sex: M History Information Citation Date.... Conviction Date ACD E;tplanation Count„ 310�:. 01/16/2011 :02/10/2011 '.592 Speed (10 mph & under in 35-55 mph zone) Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accid„nt Date Case Number 10/20/2010._ 596002. _.. IA. Name: Nelson, Eric Vernon DL/ID: 464KK6798 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: ......••":� hir 6/26/2015 IOWA --lil ff ). 0. T.;� C4V �e �'Bg.... rO oliltil Office of Driver Services �s Iowa Department of Transportation Name: Nelson, Eric Vernon DL/ID: 464KK6798 06/Jun.17. 20159 3 23FM 01 Div of Criminal investigation No.9201 P. 1 - DCI IOfta . Ia�u09 STATE OF IOWA Criminal History Record Check Request Form Tot Iowa Division of Criminal lavcatltatlox Support Operauoar Bureao, is Floor 215 T. 70 Street Des Moines, Iowa 50319 (915) 725-6066 (515)7256060 Fax 1 am renuectinv an Inwa (:Aminal ttio.r R. 'd rkA l' nn - DO Amount Number: ptytikaels) Prom: iM4rc,s7in IN s+LVc.., Dr. OIJa. A 9)-)4 p Phone: Faxt.. 314 551-59 Lost Name aweeemrl First Name mudr ) Middle Name woMw,ded Nelw\ F(;G - genion Date of bii'r't ryadeb Gander awae.ta) Social Seaurl Nlumber (,,00eemendal J Qi'�Msie ©Remak q (1— f Wo Walverlgrorrnobon. without sherd waiver From the subject of the request, a complete rrlmloal history record may net he Mumble, per Code of laws, Chapter 692.5. For complyerimlaal eGlory mord leformatloh, as saawed bylaw, ahvxys obisin a Walveridgmart from The rub ect of the rogiscot. WalverRelease_i1.a ftygin pwiiatmfervwze, o„qLwthaamddtotmftlent.rune-.wtdemrywoidaw*wlaenUWhlmvf4cfww InVaditat♦oe(RC1). Any wmin.l hluny UK oownnina" thea 1"114 by Je nCl nay be m1und u allowya by).w. Waiver Signature: I _ As of 0 � 1 S a search of the provided namo and date of birth revealed: ❑ No iowa Criminal History Record found with DCI Iowa Criminal History Record attached, DO DO k 5-19,55-0 DCI initials Rtteived Time Jun. 16. 2015 10:454Ni No. 0762 (DCI tae only) Li N /7 yN' X pv Jor. Ii. 2015 3:2)PM Div of Criminal Investigation No. 9203 P. 2 IOWA CRIMINAL HISTORY DCT 00516350 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2015/06/17 DCI:00516350 NAME: NELSON,ERIC VERNON DOB SEX RAC HGT WGT EYE HAIR SKN POB 19760605 M W 602 250 BLU HRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 19960229 AGENCY: IAD520400 IOWA CITY UNIV SEC PD CRARGE NO- 02 IA STATUTE IA124-401-3 POSSESSION/SCHEDULS I/MUSHROOMS TRK#; 010655802 CHARGE NO- 03 IA STATUTE IA124-401-1D POSSBESIONW/INTENT DELIVER MARIJUANA TRK#: 018655803 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401-3 POSSESSION/CONTROLLED SUBSTANCE SCHEDULE I/ MUSHROOMS COURT CASE ID: FECR40720 TRK#: 010655601 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19960628 COURT COSTS 19960628 PROBATION 2Y 19960626 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA124-401(1)(D' POSSESSION/ W/INTENT TO DBLIVNR/ MARIJUANA COURT CASE ID: F8CR040720 TRK#: 018655802 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19960626 COURT COSTS 19960628 PROBATION 2Y 19960628 02 ARRESTED 20070422 AGENCY• IA0520200 IOWA CITY PD CHARGE NO- 02 IA STATUTE IA124.401(5) POSSESS CONTROLLED SUBSTANCE TR)W IA001AO02 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA124.414 POSSESSION OF DRUG PARAPHERNALIA COURT CASE ID: 06521 PECRO79287 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: IAOOIAO03 un -17. 2015 3�23PM Div of Criminal Inv e s t i 1 a t i o n SENTENCE JAIL 2D DCI 00510350 PAGE 2 OF 2 DISP EFF DAT 20070919 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON—LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED, Wk CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No. 920: Y. 3