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Home My WebLink About16-054IDENTIFICATION NO. Sy 1 t _ (Office Use Only) It Jt r`IIINJkp� ti 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 19) 356-5040 (3 19) 356-5497 FAX First �• Middle 1 Last �'r 1. Name (REQUIRED) �y,.,F,.f,,// r 2. Address (REQUIRED) is 1 199 M1.fYoAA{ f�1�� ' / P fi 6>9r Email: QJ^f- y 3. Contact Information (REQUIRED) 1an.ef� lCwrl r' 72h /a(4Al Cell Phone: �rr9)g?ro y �� (All written unicatich nt via email) 4a. Chauffeur's License expiration date (REQUIRED) ��y J�7 b. Taxicab Business Name (REQUIRED)_. YC jai Cah 5. Prior experience in transportation of passengers: Z tired l/I• dd Mar p,f' 7q,}', 6 Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Pe of offense Where When -3 k1;rCWA,i aiiii 1oLj9 , T14 aura What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Have you been arrested / charged with any traffic offenses in the last five years Type of offense Where Other When What happened to the charge? (Circle one) Convicte 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? Ald 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 mme(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFI€fl DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE GRIEF RENEW You must apply for an individual Department of Criminal Investigation Report (form available upon Yequest) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)_ 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa De art ent of Transportation valid Chauffeur's license number UyAl cc Cis A? issued on 11 /ja expiring on (DJa?y/17 . 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. Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Lar - Date q/ 6 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by-FQvtieS J:=. LewoI- e, fr on this 1 9 day of P-04- 0.-, 7-o) Lj 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 Cade). Expiration to of Chauffeur's licenseis� z - 3�Y� Sign re of Police of 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. I� cis J K Kit 1 Signatme of City Clerk or designee J// v /�f �— Date Office Use Only - - Approved application DCI report State certified driving record - Website update cierWTw IDRivenoc�PPra2014ame,ded.DOC 03/2015 03/Mdr, 8. 201653:02PMCab OIv Of OrImIOal Invest Igai 1011 (FA%)3193382ND. 9272 D STAU OF IOWA 1 Record Check Request Form Tot 10wn Dlvlslon of Criminal lnvostigatlan Support Operations Bureau, 1" Floor 21511.71° Street Des Mclncs, Town 50319 (515)725.6066 (515)'721.6080 Fax Lew! P'. 1%2!002 DCl A000unr Number: 9967-F ((fapplleebla) From; _ Yellow Cab of iasva CI P.O. Box 428 Town City, IA. 52244 (319) 3384777 Phone: Fax: (319) 339.7302 I p ... --- ---^ - +.wmm.nwul L tl 77 CtdMale, ❑ramale �l (r -0a "Ifoq warver 1nJornlation: Without a signed walver from thosublact of tho request, a complgto criminal history rocord of not be. releasable, par Cade crfowo, Chapter 692.2, For Gg� 1010 criminal history -record information, as atlosved by law, always OWN a waiver alanntura Nnm #h..,.t r-...r,L. ___.._.. wal✓ar Adleaa'e: I huebyalva pfrmlallon rbrthe above regouling omaial to eonduel an (0x11 Odmlmlhlaoryremrd.hook wflh thr Dlvlslen erCrlminel lnvesdaulon (DCT), Mycflminol hirlory dBs eoaeemfng me the, Is m/Inlllned by the DCI may be released as. Allowed by law. Waiver Signature: As of ----'1"( 0 It search of the provided natno and date of birth revealed: ❑ No Iowa Criminal History R000rd found with DCT Iowa Crirninai History Record attached, DCI 71A504S DCl initiala DCT -77 (08/25/10) --• Received Time Mar. 7. 2016 8:OOAM No -9031 (DLI use Only) Mar, 8, 2016 3:02PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCT 00950864 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2016/03/08 DCI:00950864 NAME• LEWIS,JAMES EARL JR DOB SEX RAC HGT WGT EYE HAIR Sm POB 19771024 M B 601 300 BRO DAL 13LK IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT LF ARM CCH RECORD *'"* 01 ARRESTED 20120228 AGENCY: IA0620100 OSKALOOSA PD CHARGE NO- 01 IA STATUTE IA'708.7(1)(a)(1) HARASSMENT BY COMMUNICATION TRK#: KE002S901 COURT DISP081TION AGENCY: IA062015i MAHASKA CO DIST COURT COUNT NO- 01 IA STATUTE: IA706.7(4) HARASSMENT / 3RDDEGREE- 1989 COURT CASE ID: 08621 SMSM167760 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: KE002S901 SENTENCE DISP EFF DAT FINE $65 20120220 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY B$ RELEASED TO MON-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, 9272 P. 2/2 CN Iowa Department of Transportation Once^ of Univer Safwcc t I TVA; P rQei JW 532 1111 P[✓ Win 9204, l Mciti iA 5G3D6 0204 515.24-0 9424 F"V( 515 239 118.31 Convictions Citation Date Conviction Date Certified Abstract of Driving Record Ex lanation Inquiry Date: 2124/2016 DL/ID #: 247CC9583(IA) Customer #: 2915109 Name: Lewis, James Earl Jr Class: D ID Status: None Address: 121 OAKRIDGE AVE Audit #: 6484425 DL Status: VAL APT 8 Issue Date: 11/20/2012 CDL Status: None City/State: HILLS, IA 52235 Expiration Date: 10/24/2017 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: FD Box 255 Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 10/24/1977 Mailing HILL -5,14 Sex; M City/State: 522350255 History Information Convictions Citation Date Conviction Date ACD Ex lanation Cour )UR +02;02/2013 �03/01/2013 - Improper Registration Henry IA 1 Name: Lewis, James Earl Jr DL/ID: 247CC9583 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: 2/24/2016 ;i : Q. 0. T, Name: Lewis, James Earl Jr DL/ID: 247CC9583 Office of Driver Services Iowa Department of Tiansporatlon =d'