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Home My WebLink About15-264r t ^,dMP-wM®4It CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (3191 356-5497 FAX 1 Name (REQUIRED) _ IDENTIFICATION NO. 1-5— 7— Lf"cf (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 2. Address (REQUIRED) ,3 ^I EST S% a�/� �-T/ ��air� 3. Contact Information (REQUIRED) Email: Ym c°Vc9 Sar 6yns- '-19M Cell Phone: ✓?l $%�-O��j 3 (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) ,�F !o" 6zi 5. Prior experience in transportation of passengers: 13 Ye�►,es ss,��E Po o,2 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? c:> 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? AJL"> Type of offense Where When w 9 Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pro"vAe theg-me(s) Al D DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATCZFRTIF5kD DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVAEW You must apply for an individual Department of Criminal Investigation Report (form availoflle`up®n request'). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 7- 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa De art ent of Transportation a Chauffeur's license number c135��15�5' issued on 9 ['1 or expiring on 7 3 alid 0� . I understand that if I fall answer any questions in this application, that this application may be denied. I ag ee 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 o ' le 5, ClrAter 2, of the City Code. (Needs to be signefront of a Notary Public) Signature of Applicant��/ Date/0/Z)-67_ STATE OF IOWA ) COUNTYOFJOHNSON ) �2 Subscribed and sworn to before me by on this ad day of C>c365Fr ao�s \__G.��.��;�:ti� (lotary Iblic in and forte State of Iowa *****#****************S******#**#*#*#****k*#**k*************k**k*****************R********###**R*#********#*****************##**********#******* 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 theCityof Iowa City (Title 5, Chapter 2, City Code). ion d to f Cha ffeur's license 13/ h re of kalie4 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. �� S gnat -of City Clerk or designee ate I^y] C^M1 _) C_> Office Use Only o ,�� rah: ro Approved application a;: co DCI report ^" -1 State certified driving record Website update +; --- :s Cl.Nl 0.XIDRIVBADGEAPPL92014amend=a.DOC 03/2015 10?Ocf. 12. 2015411.36AMcet,Dly of -Criminal Investigation (Fnx)3MU2No.8327 P•„liwoo2 STATE OF IOWA�� Ss Criminal History Record Check +i IFRequest Form `W^wlAe”` To; Iowa Division of Criminal Investigation Support Operallone 13ureau, )" Floor 215 U. 7`4 Street Das Molnes, Iowa 50319 (51S) 725.6066 (515)725.6080 Fax I am recuestlna an ToWn Crim inn Hlgt^r Rennrd rhn�lr ...,• DCI Account Number: 9967-F ~T of applicable) From; Yellow Cab Of lovea City P.O. Box 429 Iowa City, U, 62244 (319) 338-9777 Phone: Faxi (319) 339-7302 Last Name (mondcte First Name rmendawy) Middle Name Voaommnded) ' Date of Birth (mandatory) Gender(mmdoie) 'Social,Securi ]Number r000mmanded) 07 3 ��>' �� klMale dFemale ( C �'a °'7 S Wa1yer1nf0rmall0nr Wtthcut a signed waivor from the subject of the regpost, a complgto criminal history record may not be reteasgbie, par Code of Iowa, Chapter 692.2, For complete criminal historyracord Information, as allowed by law, ohvoys obtain a woiver al nature from the subject of the request. W01Ver ReleaSe: I hereby Elva pannIstloa fir the Above requesling official to conduct An Iowa m:minal hbtory record check with tho Dlvlilon of Criminal Investipaon (Dco, Any orimrnol history data Mn Ihae h mfei�ntalnmad by the DCI may bo rdeaaad w ollowod by law. WalyerSlgnature:�/�/fir AS of a search of the provided name and date of birth revealed: ` L -f" No Iowa Criminal History Record found with DCI u' ..-1 Iowa Criminal History Record attaohed,.0CI9. : z' DCI Inldals--Z� lief-ir (ueiza lug Received Time Oct. 8. 2015 3:54PM No, 8189 r., (DCt uta only) Iowa Department of Transportation pp MCC Of brwef `.;Crwi.- I 1 till F rue I JM,x,4 531 11-21 PC) Bo 132G4. Dcs Moines 0% 5f3apdi 02114 1 '44 8124 I ;ia� 1"-2�ti 1K3! Certified Abstract of Driving Record Inquiry Date: 10/10/2015 DL/ID #: 435ZZ1025(IA) Customer #: 2308987 Name: Bradley, Roder Elliot Class: D ID Status: None Address: 2327 E COURT ST Audit #: 7383317 DL Status: VAL Issue Date: 09/27/2013 -CDL Status: None City/State: IOWA CITY, IA Expiration Date: 07/31/2018 CDL Cert Status: None 522455216 Endorsements: 3 CDL Med Status: None Mailing Address: 2327 E COURT ST Restrictions: NONE Restriction None Supplement: Date of Birth: 7/31/1965 Mailing IOWA CITY, IA Sex: M City/State: 522455218 History Information CLEAR DRIVING RECORD Name: Bradley, Roger Elliot DL/ID: 435ZZ1025 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: IOWA :r D. 0. T. Name: Bradley, Roger Elliot DL/ID: 435ZZ1025 10/10/2015 ry ca Qom. : co Office of Driver Services co Iowa Department of Transporation� .97' w,