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HomeMy WebLinkAbout15-302j r It � � 1t11M®�m11 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 3S6-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) - 2. Address (REQUIRED) IDENTIFICATION NO. E-:jCja (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 S t-ttA1 n Ir �- 74 3. Contact Information (REQUIRED) Email-\-OXen'±-orda1zG (DI yyln1'I.(AmCellPhone: 3%q -1;(o-62.3 (All written communication s1dint via email) 4a. Chauffeur's License expiration date (REQUIRED)`y )S-20.26 UI b. Taxicab Business Name (REQUIRED) _ l� r I G h Cm 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When ©LjI vD�ASOrt cz »-ll~ 89 I:1 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested I charged with any traffic offenses in the last five years? y e Type of offense Where u/q 6 -20 �20) What happened to the char ? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please prayide,the=[R`me(2}, 1U3 C; w DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATiTE ED -- DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE C�HSRI )fJEW You must apply for an individual Department of Criminal Investigation Report (form available upgli.request). c, (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0212015 Q1l APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereb cerci that issued to me by the Iowa Departmegqt-of Transportation a valid C uffeur's license number (`J 1 415 y cF II -)"r issued on S _y - ) } expiring on �/ S 2 . 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 a pW�7/ er gree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provi ' ns of the City Code. (Needs to ble signed in front of a Notary Public) Signature of Applica Date 42 )6 1 S STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by "7_c e S -x e« -Cc, C LO on this t o day of Number 729428 My .ii 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 0 t5 2020 --ill �, Signature of Policel Chief or designee t2 7th 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. v Nnatyre of -City Clerk or designee \Z`D_a �� e Office Use Only � � C1 � Approved application ` l2r � DCI report ? v State certified driving record ' Website update r7l :n. C IeTMAXIDRNBADGEAPPr92014amended.DOC 03/2015 CE Iowa Department of Transportation Ofte of Drwer Serwm (Toll Flee, W0 632-1121 E PQ BOK 92441, LIN Mtilnes, (A. 503069204 515--2244-5724 F-A)C 515239.1ll Certified Abstract of Driving Record Inquiry Date: 11/26/2015 DL/ID #: 013BB4402 (IA) Customer #: 495098 Name; Oxenford, Joel Class: B ID Status: None Stewart Address: 14749 KEOKUK Audit #: 9095213 DL Status: VAL WASHINGTON RD CDL Downgrades Type Effective End ACD Issuing JUR Downgrade 05/03/2015 05/18/7015 IA History Information Convictions Citation Date Conviction Date Issue Date: 05/19/2015 CDL Status: VAL City/State: KEOTA, IA Expiration Date: 04/15/2020 CDL Cert status: Excepted intrastate 522488594 Endorsements: NONE CDL Med Status: None Mailing Address: 14749 KEOKIJK Restrictions: Corrective Lenses, Restriction None WASHINGTON RD CDL Intrastate Only Supplement: Date of Birth: 4/15/1960 Mailing KEOTA, IA Sex: M City/State: 522488594 CDL Downgrades Type Effective End ACD Issuing JUR Downgrade 05/03/2015 05/18/7015 IA History Information Convictions Citation Date Conviction Date ACD Ex lavation 1: 1 1111 JUR 07/08/2011 09/20/2011 IN83 Improper Start Johnson IA Name: Oxenford, Joel Stewart DL/ID; 013BB4402 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that 1 am the custodian of the records held by the Office of Driver Services, that this is a true and accvzc to copy of an official record currently in the custody of said Office, and that I have been authorized by the Director cl 9ne IowaFD2partment of Transportation to so certify. l`` d its t"7 In witness whereof, I have caused my signature and the seal of the Department to be set upon this documenf._ t Ankeny, Io" -I this date: s .L" :5z 11/26/2015 IOWA D. 0. T. • � �=�1 y Office of Dnver Services Iowa Department of Transporation Name: Oxenford, Joel Stewart DL/ID: 01 36 8440 2 r-� 0 E'i'1 n .71 5 11•Nov. `23. 201) 3 20 PM LO Div of Crlminal Inve)tigatlon No. 1656 P. 4/5 i DCI IM 10004 STATE OF IOWA A, Criminal History Record Check Request Form Te: lewa Division orcrimidal Iaveatigatlon Sapport Optrations Burcaa, I' Floor 215 IG 7* Street DesMolone'lows wig (SIS) 725-00 (515) 7254NO Fat I am reouestinr an Iowa Criminal H1Story Reoo,d Check on: ocI account Nurnber: 38�.__ tlraPPli� e From: Tax i Phone: 1(31R) 338- " Fa:l.. 3t9 551" 5 )44 0 Lust Name m Aw First Name msnda Middle Name D-? hew& � �ae1 SfeuJ a� f Date of Hirth (mandato I Gender Social Secu by Number recon ©y l6 rJ q� de ❑Femrle , /% O S - / 6 Waive► Infornsa&N. Without a signed waiver from the subject of the request, a oomplete criminal history record may not be releasable, per Code of Iowa, Chapter 021. For complete criminal hlstary record infortaattoa, as apowed bylaw, always obtsko a w0versiguoure from the tub ed of the r apt. Waiver lfekaM I hmby fWs pamiwlvn for ur tbow re(,uevtina ataeW m aaoduct ae rcwa cdmmd haply reowd CIMX Wah aw Dlvo-ion of cno'a Imms"anfDOD. Anyann`La'ahistmdaacaIrma - ty tln mytaaliovadbylaw. Walver Signature. d Received Time Nov 18 2015 IMIAM AM Ne.1110 Iowa Criminal History Reco11 d Check Results,r As of a3 a search of the provided name and date of birth revealed:= = , ❑ No Iowa Criminal History Record found with DCI C �f Iowa Crlminal History Record attached, DCT 439 7s5a' DC DC1 initials_ 2 oo ,- -0,z) c";Mi Received Time Nov 18 2015 IMIAM AM Ne.1110 I II Nov.23, 21}15 ; 2QPM Div of Criminal 1 n v e s t i I a t i D 0 IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00397552 NAME: OXENFORD,JO]&L STRWART DOE SEX RAC HOT 19600415 M W 510 19600514 ADDITIONAL IDENTIFIERS DCI 00397552 PAGE I OF 1 DATE PRINTED - 2015/11/23 WGT EYE HAIR SKN POB 150 BLU RED FAR IA CCR RECORD *** O1 ARRESTED 19891111 AGENCY; lAOS20000 JOHNSON CO 50 CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: L37091702 COURT DISPOSITION AGENCY: SA052015J JOHNSON CO DIST COURT COUNT NO- 01 1A STATUTE; IA321J.2 OPER VER WK INT OWI CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: L37091701 SENTENCE DISP EFF DAT JAIL 2D 19900125 FINE $500 19900125 CREDIT W/TIME SERVED 614 19900125 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.1656 P, 5/5 rv.a a G cr+ " t.0 e �