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Home My WebLink About16-038CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-SO40 (319)356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) 3. Contact Information (F IDENTIFICATION NO. o ( ffice se Only) APPLICATION FOR TAXICAB I 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 (All wri 4a. Chauffeur's License expiration date (REQUIRED) bb Taxicab Business Name (REQUIRED) _ 5. Prior experience in transportation of passpWers: _ 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? /�i1/�CCq-`7 k What/IY3pp ne'Pto t o harge. ( r, e b ) Convicted Dismissed Deferred Suspended Plead Guilty Other 7, Have you been arrested f charged with any traffic offenses in the last five years? 8. What happened to the Type of offense Where When 9 Have you ever applied to be an Iowa City taxi driv IL2sg a different name? If yes, please ptdv de th�name(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATEICERTIFIED�' DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE -61,41i REVIEW-, You must apply for an individual Department of Criminal Investigation Report (form available upon requgst). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0212015 d /f' APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I h re c at I haves&fie me by the Iowa D pa me of Transportati n ali haufil license number ti V ssued on expiring on I understand that if I falsely answer any questions in this ap lication, 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 -`v// (/Y �r \ Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by SLV r `ANry or Sin ro_(_ on this day of �Plota Public in and for the State of Iowa I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is ro 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 c) t I17IZb 1� Signature of PoliceC ieh f or designee L22,S1 f 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. Crli e, -2 - 9-1 — A:_1 Signatu ity Clerk or designee Date Office Use Only ' r' Approved application DCI report State certified driving record Website update cher AXIDRIe Die PPL92014amendea,00c 03/2015 WWADOT tAl SMfRTE I *PUI-a I CUSTOMER URIt.E1 li(aLet.gC/ Office of Driver Services PO Bor 9244 i Des Maines, IA 611306-3244 Phone: ;15-244-5124 1 SM-532-1121. f Fa.*.: 515-239-1817 wwArowadot,g3v Certified Abstract of Driving Record Inquiry Date: 2/23/2016 DL/ID #: 435AA5012 (IA) CDL Permit Class: None Customer 7r: 224854 Class: D CDL Permit Issue None IOWA Date: Name: Shrock, Steven Warner Audit #: 6581207 CDL Permit None Iowa Department of Transportation, Expiration Date: Address: 4487 490TH ST SE Issue Date: 01/02/2013 CDL Permit None Endorsements: Expiration Date: 01/17/2018 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522408288 Endorsements: 3 ID Status: None Mailing 4487 490TH ST SE Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA 522408288 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 1/17/1946 CDL Cert Status: None Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation county ILie 01/31/2015 02/03/2015 M14 Fail to Obey Traffic Sign/Signal '.Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. /accident Date _... _. Case [number IJI: 02/17/2012 _...._ ..673587....._ _. _.. _..... IA Name: Shrock, Steven Warner DL/ID: 435AA5012 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: 'OOeVE:UCIf 2/23/2016 IOWA Office of Driver Services Iowa Department of Transportation, 02,Feb.-4. 2016510: 41 AM cab Div of Criminal 1nvestia.ation No. 6842 P. li3 '•, (FAX)3193362,,,,, , DCI Account Number; 9967-F (Ifeppllcablc) To: sown Division of Crlminel Investigation %ram: Support Operatlons Bureau, P Flyx oor iCellow Cab of Iowa C 215 E. 7 Street T70.$0%q28 DOS Malnea, Iowa 50319 (515)725-6066 ' Iowa City, IA. 52244 (515)'725.6080 Fax (319) 338.9777 Phonof Fox; (319)339-7302 I am re uestin an Iowa Criminal Histo Record Cheok on: Lagt Nn\stria (mm�tlslo /^ FirsttName mmdalory' x Mlddlu N/a�Ame (rcoomme�ded) VtJL ` I to V �� .f� /) -r" ` X� Dans of GenJd6r (mandsie )" "' "sOViaf I/a9oepri 'NvUVttiha`� (rieommdno6d)" lBlrth�7menaa/cargyl / Walverinformall0n. Without a signed waiver from the subjeot of the request, a aomplOte priminal history record may not be releoaable, per Code Iowa, of Chaptor 692.2. For camnlate ortminsl h(atory raeord obtain A wpr., lverslanafure from thauhln�rrt6......... Informationoq allowed bylawa,lwaya , , WalY8r!(e1traSe: I hembyglve permission for tha above requesting oftlefpl ro eonduel M Iowa etlminaI alrtoryreoord oheok Willi the plvhlon ofCrlmInd InvmIISVIOo(l1C0. Any criminal hislory data c011anniiiii me thit Is inefinullied by Vie DCI AAY be rclonod w Allowill by 14w, Walver Signature; (OC1 Use only) As of (4>—, a search of the provided name and date of birth revealed; No Iowa Criminal History Record found with DCI Iowa Criminal History Record attached, DCI 9 19�0 DCI initials. DCI -77 (08125110) Received Time Feb. 2, 2016 10:01AM No -6456 Feb. 4. 2016 10:41AM Div of Criminal I n v e s t l g a t l o n ADDITIONAL IDENTIFIERS SC L CHK CCH RECORD +'-+ 01 ARRESTED 19721124 AGENCY: IA077C000 POLK CO SO IOWA CRIMINAL HISTORY CHARGE NO- 01 DANGEROUS DRUGS /POSSESSION OF CONTROLLED SUBSTANCE TRK#: L07373601 _ DCI 00186530 AGENCY: IA077015J POLK CO DIST COURT FELONY CONVICTION DANGEROUS DRUGS/ POSSBSSION/CONTROLLED SUBSTANCE CHARGE CLASS: MISDEMEANOR CONVICTION PAGE 1 OF 2 SENTENCE PLEAD GUILTY DATE PRINTED - 02 ARRESTED 19740430 2016/02/04 DCI :00186530 CHARGE NO- 01 IA STATUTE IA204-401 DANGEROUS DRUGS/POSSESSION/CONTROLLED SUB/INTENT TO DELIVER NAME: SHROCK,STEVE COURT DISPOSITION AGENCY: IA007015J BLACK HAWK CO DIST COURT SHROCK,9TRVEN WARNER POSSESSION/CONTROLLED SUBSTANCE WITH INTENT TO DELIVER CHARGE CLASS: FELONY CONVICTION DOB SEX RAC HGT WGT EYE HAIR SKN POB 19460117 M W 508 180 GRN BRO MED IA ADDITIONAL IDENTIFIERS SC L CHK CCH RECORD +'-+ 01 ARRESTED 19721124 AGENCY: IA077C000 POLK CO SO CHARGE NO- 01 DANGEROUS DRUGS /POSSESSION OF CONTROLLED SUBSTANCE TRK#: L07373601 _ COURT DISPOSITION AGENCY: IA077015J POLK CO DIST COURT 'T7 COUNT NO- 01 IA STATUTE: DANGEROUS DRUGS/ POSSBSSION/CONTROLLED SUBSTANCE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L07373601 SENTENCE PLEAD GUILTY JAIL 15DD 02 ARRESTED 19740430 AGENCY: IA0070300 WATERLOO PD CHARGE NO- 01 IA STATUTE IA204-401 DANGEROUS DRUGS/POSSESSION/CONTROLLED SUB/INTENT TO DELIVER TRK#: L07373701 COURT DISPOSITION AGENCY: IA007015J BLACK HAWK CO DIST COURT COUNT NO- 01 IA STATUTE: POSSESSION/CONTROLLED SUBSTANCE WITH INTENT TO DELIVER CHARGE CLASS: FELONY CONVICTION TRW L07373701 SENTENCE DIS? EFF OAT SUSPENDED PRISON 5Y 19151025 PROBATION 19751025 03 ARRESTED 19900722 AGENCY: IA0520000 JOHNSON CO 50 CHARGE NO- O1 IA STATUTE IA236-12-2 ASSAULT/CAUSING INJURY/ DOMESTIC ABUSE TRK#: L07373BOI COURT DISPOSITION AGENCY: IA05201.5J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE•. IA236-12-2 ASSAULT CAUSING INJURY CHARGE CLASS: MISDEMEANOR CONVICTION No� 6842 P. 2/3 _ m 'T7 Feb. 4. 2016 10:410 Div of Criminal Investigation TRK#: L07373801 SUBSTANCE ABUSE EVALUATION SENTENCE PROBATION Iy SUSPENDED 30D BATTERERIS EDU PROD DCI 00186530 PAGE 2 OF 2 DISP EFF DAT 19901212 19901212 19901212 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 IDENTIFICAT104 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. 6842 P, 3i3