HomeMy WebLinkAbout16-040IDENTIFICATION NO. ! L —q �in
f 1 (Office Use Only)
APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER
CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday- Friday)
410 East Washington Street
Iowa City. Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application
(3 191 356-5040
(319) 356-5497 FAX
First Middle Last
1. Name(REQUIRED) 56I#AkFS11 r-&-a(44-ELC }f LOu ✓}N
2. Address (REQUIRED) 30'3Cn 't-IfwQ WP S4 TlAA CxhJ rA 5�145
3. Contact Information (REQUIRED) Email: »>M Cell Phone:
(All written communication sent via email)
4a. Chauffeur's License expiration date (REQUIRED) 1 Igo l b4L
f
b. Taxicab Business Name (REQUIRED) IMcrif(o5 'Telt -,
5. Prior experience in transportation of passengers: ali t, -m-4 4
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? _f�0
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? Il
Tvpe 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? 100
Tvpe of offense Where When
9 Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide't e r5 e(s}-t
Y\b , s� 7
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED -g.-
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 hereby certify that I have issued to me by the Iowa De a ent of Transportation a valid Chauffeur's license number
?Oay3R 8.4,5`6 issued on 2 otb expiring on aaa 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 pro,&ions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant (kuv�m �Date y 6
STATE OF IOWA )
COUNTY OF JOHNSON 1
C�
ncr bed and sworn t before me by Cz +�1�5 - i JCt Wyk—on this day of
P P e. C 1)1t!_ k' /I( (C�
KELLIE K. TUTTLE Notary 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 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
Signa r b olice 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.
zr�,
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Signat of City Clerk or designee
ate
Office Use Only c;
Approved application .j
DCI report
State certified driving record "'_
Website update
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Clerk/ lDRIVBADGE PPL92014arnended.DOC 0312015
401U%#1vA00T
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Office of {River Services
g0 Box 9204 Des Moines, IA K3O6-92f,4
Fhole:. 515 244-9124 1 3CC-532-1121 I Fal:: 515-239-1P37
WAIN i3Wer.it3ti3LJV
Certified Abstract of Driving Record
Inquiry Date:
2/12/2016
DL/ID #:
302BB2858 (IA)
CDL Permit Class:
None
Customer #:
1808601
Class:
B
CDL Permit Issue
None
Date:
Name:
Calloway, James Michael
Audit #:
4986660
CDL Permit
None
Expiration Date:
Address:
2110 N DUBUQUE ST
Issue Date:
02/03/2011
CDL Permit
None
Endorsements:
Expiration Date:
01/20/2016
CDL Permit
None
Restrictions:
City/State:
IOWA CITY, IA 522451624
Endorsements:
NONE
ID Status:
None
Mailing
2110 N DUBUQUE ST
Restrictions:
NONE
DL Status:
VAL
Address:
Restriction
None
CDL Status:
ELG
Mailing
IOWA CITY, IA 522451624
Supplement:
CDL Permit Status:
ELG
City/State:
Date of Birth:
1/20/1968
CDL Cert Status:
None
Sex:
M
CDL Med Status:
None
CDL Downgrades
Type
_ -f'eetive
..:04/30/2014
. .
..lard
ACD Issoiwz JUR
Downgrade_..
_.-.. -IA
History Information
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
�x:ex.id:ctrt DaC'e Case Number I U R
08/08/2013 ....754691
09/18/2015 1879129..
SA
Name: Calloway, James Michael DL/ID: 3D2BB2858
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:
>.•"•"'• 4
2/12/2016
IOWA*
fgfl&S�
Office of Driver Services
Iowa Department of Transportation
011 eb.17. 20161 2:51 PM div of CrlmioaI Investigation
STATE OF IOWA
Criminal History Record Check
Request Form
To; low@ DNAIon of Crlmlual luvert)aattoa
Support Opereriose bureau, t' Floor
213 L Ta Street
Do$Malaea,laws 50319
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(515) 715-6000 FM
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Waiver Information: Without it alaaed vralver from the ambled of the requeou a toalpleto crlml@al hlatory record may ant
be releasable, per Code of Ielra, Chapter 69 . Porgy erlmtAal bbtory record la(ormatlab,a@ Wowed by 10%alw@ya
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Wartier Slgaarure:
Iowa Criminal Iilatory Record Check Results tnC1 aNri
As of — 1 ') a soarch of the provided name and data of birth revealed:
No lows, Criminal History Rewrd found with DCI
0 Iowa Criminal History Record atteahed, DCI # _.J '
DCL initials_w"
DCI.77 (0825110)
Received Time Feb. 15, 2016 10:04AM No. 7308