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Home My WebLink About16-050IDENTIFICATION NO. � C— D -_`� O l (Office Use Only) rlll h 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 52 240-1 82 6 Failure to complete the "required" information will result in denial of the application (319) 356-5040 (3 19) 356-5497 FAX ,First Middle Last 1. Name (REQUIRED) Xle— dArU /q cak"c[5 2. Address (REQUIRED) 3,� C l,ba sa-.1 __h6 �n G; Jn 3 Contact Information (REQUIRED) Email: /n3,6�A:ZL.E5"1c. 0/775A, ee.4" Cell Phone: (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) Ye1104'/ 5. Prior experience in transportation of passengers: .;wk 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? /70 Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where h0 When 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 year's? -- ` 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) /7 U 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 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 2,2�'AP issued on expiring on G�/4��1�. 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 provisions of Title 5,, h%/apter 2, of the City Code. (Needs to be signed in front of a Notary Public) �6 G��p Signature of Applicant Date 911".1d014, STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 11✓11 c n A 2N . Ea r1 t 5 on this In day of M air <-L Z —/ l_t 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 Signature P ice Chief or designee /�/-o 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. SignatGre of City Clerk or designee Date Office Use Only Approved application DCI report State certified driving record Website update cierWrMDRIVRADGEAPPL92o14ameodelDOC 0312015 .1 V V Vt% v v I yr mi0r, radotgav SMARTER I SIMPLER, I CUSTOMER DRIVEN, •a• - office ofDriven Services PO Box 9204 1 Des Moines, A 50306-9204 Phone: 515-244-9124 E 8Q0 -A52-1122 11515-239-1837 www: snvadot gov Certified Abstract of Driving Record Inquiry Date: 3/3/2016 DL/ID #: Customer #: 687190 Class: Name: Earles, Michael Allan Audit #: Address: 32 GLEASON DR Issue Date: 06/29/2013 CDL Permit Expiration Date: City/State: IOWA CITY, IA 522405838 Endorsements: Mailing 32 GLEASON DR Restrictions: Address: Restrictions: Restriction Mailing IOWA CITY, IA 522405838 Supplement: City/State: DL Status: VAL Date of Birth: 6/15/1956 VAL Sex: M ELG CDL Medical Examiner's Certificate Certificate Specifics _ Medical Examiner First Name Medical Examiner Middle Name Medical Examiner Last Name Medical Examiner License Number Medical Examiner National Registry Number Medical Examiner Jurisdiction Medical Examiner Phone Medical Examiner Type Medical Certificate Issued Date Medical Certificate Expiration Date Date Added to CDLIS Driving Record Name: Earles, Michael Allan DL/iD: 2281 228AD8474 (IA) COL Permit Class: None A CDL Permit Issue Date: None 7084993 CDL Permit Expiration None Office of Driver Services Date: Iowa Department of Transportation 06/29/2013 CDL Permit None Endorsements: 06/16/2018 CDL Permit None Restrictions: NONE ID Status: None Corrective Lenses DL Status: VAL None CDL Status: VAL CDL Permit Status: ELG CDL Cert Status: Non -Excepted Interstate CDL Med Status: Certified Explanations _._ .,..._ .•Jeremy..... Lewis Nelson 002023 ...... _... 7661525613 IA (319) 358-5736 Physician Assistant 11/16/2015 11/16/2017 ..... 11/17/2015 History Information CLEAR DRIVING RECORD Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the custodiar 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 beer authorized by the Director of the Iowa Department of Transportation to so certify. in witness whereof, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: Name: Earles, Michael Allan Dill 228AD8474 n.� Bi '�`O@dEH16i r' 10WA "; 3/3/2016 p a 9y V1 DB�VEs o�@c Office of Driver Services Iowa Department of Transportation t.7 Name: Earles, Michael Allan Dill 228AD8474 FfelvlaY. 1. /UIbw11:49PIVlL,,,P1v 0 GYJ(in inaI Investigation Sol , So Criminal History Request Form Yo: IOWA l ivision of criminal lnvesligattorl Support Operations Sureau, 1" Floor 215 E. 70' Street Des B10111es, Iowa 50319 (515) 725-6066 (515)725-6080 Fax to �e//le�/9f; ler Record Check First Name /1(/C. 414C -•C OS/04/2016 ll:PNII C'' 9)6'/42AP. 1/1/002 ttZi� c anti"r... 1DC1 Account Number: _ q (if applicabla) From; City of ION'a_Clty City Cleric's Office d]0 E, Washington Street Toxo City, iA 52240 Phone; 319-356.5041 Fax: 319-356-5497 Male ❑Female Q Lt.cN yds - 2L/-dY/,�s WRiver Information: Without a signed waiver from the subject of the request, A complete criminal history ieeord may not be releasable, per Code of Towa, Chapter 692.2• FOr Curti crier 4isl history record Information, as allowed by lasv, ahvays obtain a waiver crvn oflu•a f..,.oiii Wai Release: Htfoloytiv,peiminion for Lite above requcsling official 10 conduct an IOWA criminal 13NOry record check wish the eiviMli of Criminal hn'estigallon (DCI), Any criminal history date concerning me tbol is munlaiaed by the bCl maybt released as allowed bylaw. : — c•• CS7 Waiver,Signware: Iowa Criminal History Record Check Results t6crt eovfs3 As of 3 _, a search of the provided narne and date of birlh revealed; ( No Iowa Crimilied History Record sound with DCI ❑ Iowa Criminal History Record attached, DCT DO initjals DCI -77 (08/25/10) Received Time Mar. 4, 2016 10,13AM No, 8923