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HomeMy WebLinkAbout15-267►r a► �a �Im!®�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) , 2. Address (REQUIRED) IDENTIFICATION NO. 15 - 7 (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 Middle t ���I 31q- 3 (o,53 7� 3. Contact Information (REQUIRED) Email:�70 1q,,S�G ��yCd49% L�,C �1?� Cell Phone. (All written communication sent via email) 4a. Chauffeur's License expiration date b. Taxicab Business Name (REQUIRE[ 5. Prior experience in transportation of 6. Have you ever been arrested /charged with an misdemeanors nd/or felonies in this State or elsewhere? DSU 4-h Where -4-/ - -) C) U When What happened to the charge? (Circle one) = G CD Convicted Dismissed Deferred Suspended Plead Guilty �erc-) Have you been arrested / charged with any traffic offenses in the last five years? Q/ 0 ry Type of offense Where M en >> :rt 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? Ain 0 Type of offense 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) 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I her ce cid that I lave issued to me by the Iowa Department of Transportation a valid Chauffeur's license number ZPbfC��1 . � issued on -,;t - E expiring on 10-9- Iq . 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 provisicnrf Title Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date LO- -I-?- S1'Zh STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by SO.�LA� on this 2Z day of rti. V- 2�,C 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 / t) A &61 f rz�_ Signature of Perice Chief or designee 1a12�12_6)s 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. Signatu eof City Clerk or designee ie7ZZ-r Dat Gle, r IDRIVB DGEAPPr9201�..�ded.Doc 03/2015 O Office Use Only � 1 Approved application 9 DCI report State certified driving record `' Website update Ln Gle, r IDRIVB DGEAPPr9201�..�ded.Doc 03/2015 Oct.27 2015 3:39PM Div c` Criminal Inv estlgatlon No. 0942 1''. 1/2 Frc,T:Clty ee Ic�+e Clly Gi nrR 0111.. 319 asc64B7 10/25/2016 1510 x311 P,OG2/002 STATTEUF IOWA Criminal Hist©>ry Record Check Request Farm "Po: lulva Division of Criminal Investigation SUPPor1 OFeratious Burtau, 1°I Floor 215 E. 7" Street DEs Moines, lova 50319 DCA Account Nwnbw: 1� (ilappluahle) Ftuft; Git cf Iowa Ci[F' City Cleric's Office 410 E. Washin [mt Streel 725-6080 Fax )'hone; .319.319-3365041 ,,,__, Fax: 379.366-5497 __. Iowa Criminal History Record _Check results As of W 15 , a search of ate provided natne and date of biiih No Iowa Criminal History Record found with DCI Iowa Criminal I•Iistory Record attached, MI DCI initials,AO �.. DCI -77 (08/21/10) .- . ..n n11r , ne ml AI- n191 (ocl use only) -`. r 10 UJ 0ct.27, 2015 3:39FM Div o' CrlmInaI Investigation ADDITIONAL 1DENTIFIERB TAT BACK TAT L SHLD CCH RECORD *+* 01 ARRESTED 20060602 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA715A.6 CREDIT CARD FRAUD TRK#: 101882401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA714.2(5) THEFT STH DEGREE - 1978 COURT CASE 20: 06521 AGCR076201 CHARGE CLASS; MISDEMEANOR CONVICTION TRK#1 : 10188 24 01 SENTENCE DISP EFF DAT FINE $65 20070504 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. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION No 0942 F, 2/2 IOWA CRIMINAL HISTORY DCI 00777734 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2075/10/27 DCI:00777794 NAME; SEALS,SOPHIA LORRAINE DOB SEX RAC HGT WGT EYE HAIR SKN POB 19721009 F B 506 195 PRO BLK IL ADDITIONAL 1DENTIFIERB TAT BACK TAT L SHLD CCH RECORD *+* 01 ARRESTED 20060602 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA715A.6 CREDIT CARD FRAUD TRK#: 101882401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA714.2(5) THEFT STH DEGREE - 1978 COURT CASE 20: 06521 AGCR076201 CHARGE CLASS; MISDEMEANOR CONVICTION TRK#1 : 10188 24 01 SENTENCE DISP EFF DAT FINE $65 20070504 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. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION No 0942 F, 2/2 ZA 00T { a �r,.rt r g- frr = e rl�,iowatiotgov S,,,�i' [00' I <HM Ew I USTN,,e, Lt fl �L Inquiry Date: 10/22/2015 Customer #: 2462699 Name: Seals, Sophia Lorraine Address: 60 PENN OAKS DR APT 4 City/State: NORTH LIBERTY, IA 523179462 Mailing 60 PENN OAKS DR APT 4 Address: Mailing NORTH LIBERTY, IA City/State: 523179462 Date of Birth: 10/9/1972 Sex: F office of Driver Services PO Box 52204 ; Des Moines, IA 50306-92G4 Fhone_ 515 244-9124 1 800-532-1121 1 Fac 51 E-239-1 _q27 www lcwwauot. goov Certified Abstract of Driving Record Dll #: 960AA9824 (IA) CDL Permit Class: None Class: D CDL Permit Issue None Date: Audit #: 9450095 CDL Permit None Expiration Date: Issue Date: 09/25/2015 CDL Permit None Endorsements: Expiration Date: 10/09/2019 COL Permit None Restrictions: Endorsements: 3 ID Status: EXP Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Seals, Sophia Lorraine Dil 960AA9824 Pursuant to Iowa Code §321.10, I, Kim Suoek, 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: Name: Seals, Sophia Lorraine DL/ID: 960AA9824 10/22/2015 Office of Driver Services Iowa Department of Transportation