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HomeMy WebLinkAbout15-15831 `III CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ IDENTIFICATION NO. !!�-- 1,�— (Office Use Only) APPLICATION FOR TAXICAB! MOTORIZED PEDICAS 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 Middle 2. Address (REQUIRED) &Y S9-�f,—irP�1�J ��15 3. Contact Information (REQUIRED) Email0'W1k U111Pu�-11u1ff11^/l ( , OaM Cell Phone cj',3L Oq9 (Alf ritten ommurii' ion sent via email) J jVbejucAaj'1li 4a. Chauffeur's License expiration date (REQUIRED) C,;31 a� I �! vyll b. Taxicab Business Name (REQUIRED) _�l��.l no 0 5. Prior experience in transportation of passengers: J 6. J7 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 Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where What happened to the charge? (Circle one) When IA 1K} Convicted Dismissed Deferred Suspended Plead Guilty Other J8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _ Where When 9. Have you ever 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 REVIEW You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 hereby ce tlfy that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number I3 X 3� -1 issued on 5 - I IS expiring on ( I S , i K . I understand that if I 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 L /Y� t C Q _ 1 1 Date h 3C) S +****#+#++****************+*+*++#*+#++w#####1111+***ww1*w++lkw kkk.kk+********1111*+*k+#+*+**#1x1111#ww*++.+.1111w**#+k*kwk**-kw*-w***wwk:**x**k**** STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by `` •--,xst� t� �tr' on this day of N �..�,sE- aol� and fot the Siam 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). I t I Expiration date of Chauffeur's license It lu5 As Signature i 4 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. Signat of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update 1 Dat cierWTAxIDRN6ADGEAPPL92014amended. Doc 0312015 AC Iowa Department of Transportation 0tv' +of ()five( senuces d TClf Free) 532 1121 POBox 02K ©es Mainfs, San 56306,92114 514144-9V4 1-7kX' .51'5239 1 &3 f Certified Abstract of Driving Record Inquiry Date: 7/31/2015 DL/ID #: 713XX3757(IA) Customer #: 3007526 Name: Smith, Jessica Lynn Class: D ID Status: None Address: 305 S CENTER ST Audit 9: 90S0413 DL Status: VAL Issue Date: 05/01/2015 CDL Status: None City/State: LONE TREE, IA Expiration Date: 11/05/2018 CDL Cert Status: None 52755 Endorsements: 3 CDL Med Status: None Mailing Address: PO BOX 593 Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 11/5/1982 Mailing LONE TREE, IA Sex: F City/State: 527550593 History Information Convictions Citation Date Conviction Date ACD Ex lavation Coun JUR 07/22/2011 09/19/2011 M14 Fail tc Obey T1fhc Si n/! i nal Johnson IA Name: Smith, Jessica Lynn DL/ID: 713XX3757 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: 7/31/2015 IOWA f t Q. 0. T 41 C1114 Office of Driver Services Iowa Department of Transporation Name: Smith, Jessica Lynn DL/ID: 713XX3757 071 Aug. 3. 2015;012: 34 Mab cDiv of Criminal investigation (Faz)310336271No4462 P, 1%3002 un Pp„�STATE OF IOWA vr NH .St0'1o�ltd }1Al1Af"�Criminal History• s e Check RequestForm 'M rr:.�anxTJ` Tot Iowa Division orCrindnal Investigation Support Operations Bureau, 1" Floor 215 E. 7” Street Des Molnes, Iowa 5D319 (515)725.6066 (515)'7256080 Fn% x.n s t sv am a Imandal 1 Smith Date of Birth (rnmdnory) tl- 5•��-. Waiver ) be release i P-SOCQ or DC1 Account Number; 9967-F (Ir ppplloablc) From; Yellow Cob of Iowa CIN P,n.13OX 428 Iowa City,1A., 52244 Phone: (319) 338-9777 Fax, (319) 339-7302 11 Maio pFemale >'l n 82og 5z5 rinarson., without a elgned welvor from the subject of the regpest, a complete pr1minal history rcoord may not per Code of Iowa, Chapter 691.2, For co_ mnlete crlminnl history rocor(t Inform atlon, as allowed bylaw, always T -31E aturo from. the subloet of the reaunas. W71"P ROWNe: 1 hereby elvo permhslon for the above request ng olilalal to eonducl an Iow lnvaa atNnlnal hlatorymeord ehEEk whh rhe Division otCrlmfnel nlgulan (DCq. Myenminal hhiorydeta concaming mE lhat la malmallhed bytho DCI may be rokssad m alloweq by law, Waiver SlanarurS;�4/YThf'A� /flYh X41-1 As ofa search of the provided name told date of birth revealed 11 No Iowa Criminal History Record found with DCI Iowa Criminal History Record attached, DCI #,—:2&2n5Q DCI initials DCI -77 (08125110) Received Time Jul. 31. 2015 9:59AM No, 2102 PCI use only) u I w o0 -D o Ir Aug, 3, 2015 12:34PM Div of Criminal Investigation CHEST TAT L FOOT IOWA CRIMINAL HISTORY L WRS TAT L WRST TAT DCI 00782950 NECK MISDEMEANOR CONVICTIONS ONLY R ANKL TAT R FOOT TAT PAGE 1 OF 2 RF ARM TAT DATE PRINTED- DCI.00782950 2015/08/03 NAME: HESSELTINE, JESS ICA LYNN SMITH,JESSICA LYNN DOB SEX RAC HOS WGT EYE HAIR SKN POB 19821105 F W 506 195 BRO BRO IA ADDITIONAL IDENTIFIERS TAT CHEST TAT L FOOT TAT L WRS TAT L WRST TAT LP ARM TAT NECK TAT R ANKL TAT R FOOT TAT R THGH TAT RF ARM TAT UL ARM TAT UR ARM PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 20060512 AGENCY: IA0520500 NORTH LIBERTY PD CHARGE NO- 01 IA STATUTE IA124.401(5) POSSESS CONTROLLED SUBSTANCE TRT(# : 101941101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124,401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCRQ76832 CHARGE CLASS: NON CONVICTION TRK#: 101941101 SENTENCE DEFERRED JUDGEMENT PROBATION lY DISCHARGED FROM DEFERRED JUDGEMENT 02 ARRESTED 20120722 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA124,401(5) POSSESSION OF A CONTROLLED SUBSTANCE TRK#: lAO098701 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124,414 POSSESSION OF DRUG PARAPHERNALIA COURT CASE ID; 06521 SRCR098807 CHARGE CLASS: MISDEMEANOR CONVICTION No 4462 P. 2/3 DISP EFF DAT APPEAL DATE 20061129 20061129 20070529 20070502 Aug. 3. 2015 1210M Div of Criminal Investigation TR$4; 1A00ES701 SUBSTANCE ABUS$ EVALUATION SENTENCE JAIL 2D DCI 00782950 PAGE 2 OF 2 DISP EFF DAT 20121203 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 DCT, IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE ID$NTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED, WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION i No. 4462 P, 3/3