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HomeMy WebLinkAbout16-062,r CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1526 (319) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. f I�P - h�Z (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 First 1. Name (REQUIRED) f"r 2. Address (REQUIRED) a( (?W �Y 3. Contact Information (REQUIRED) Email: Middle I L u LrlLr [{tl F�/f�y]y, /• (VM Cell Phone: 3f S .o 40 a (All wri$en c mmunication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) U �� i 7II� "1 -7 ( b. Taxicab Business Name (REQUIRED)_. L�Q lyo,I tri! 6'{ 5. Prior experience in transportation of passengers: { f r OkC 'c � 2. rl Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? ( (- -S 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? Type of offense What happened to the charge? (Circle one) Where ti When Convicted Dismissed Deferred Suspended Pad G y. Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? S Where TILA AA C 4 d -D ) O 9 Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) Y1 D DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATS CERTWIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF RE -VIEW You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) ' 0212015 R APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certifyat I have issued to me by the Iowa Depart ent of Transportation a valid Chauffeur's license number f� 1 At� 33U issued on 0 V r expiring on C� 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) 1 Sig nature of Applicant Date of STATE OF IOWA ) COUNTY OF JOHNSON 1 Subscribed and sworn to before me by II -e goa l b r r& on this ,__2- day of 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 > l l (� 0 �" �, v- 3 Signature of Police Chief or designeeI Dat 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. Signature of City Clerk or designee 3/ D to A - Office Use Only � W Approved application DCI report: State certified driving record Website update Q1 r Cle*UMDRNBADGE PPL92014.mended.DOC 03/2015 N,!ar.11. 2016 11:03AM Olv of CYlminaI Investigatloo N'o.9817 P, lit FYO m,e:�[y 6Y IOwo euy OIorK Unloe 319 36 SS 4q7 03/14/2016 11:48 0433 P.002/002 S I'ATE OY• IOWA A } criminal dist©ry Record Check 0� , Request Forin l To: Iowa Divlsiml of criminal luvestigation Support Operations Bul'cau,10 Floor 215 E• 7"' Street Des Alotnes, lova 503]9 (515) 725-6066 (315)'125-60410 rax 8q 0 Check DCI Account Number: _%c� (ifnpplicablej From: Ci tYaP10�_-- City Cicrhls Office `— `—'- 4101',. lVashin�tU11 Strccf _ _Iowa Clly, IA 52240 Phone! 319-356-5041 — Fax; 319-356-5497- ILYMale ❑Female iddle Na 0 waive!' RafOralaffolt Without a signed waiver 6'0m the subject of the request, a complete criminal history record may not be releasable, per Code of Towa, Chap[er 6922. Cm co. mniete criminal history record information, as allowed by lam, ahrays oblainewalversl naturefromtheSubject ofthe request. WalY61' Release: j he«by glut permission !ar Vu: above regnesdnt omcial to conduct an Iowa crim]nal nisi ary mord ehcck wil�b pivision of Criminal luvesligaliml (pCl). Any criminal W510D, dais conccming me 111A4 maintained by IhcDCI maybe released es auo,ved by le+v. E!�! I•YRiVB!'S[b l?fflf!!'C:_ �_-���� _.. `n�. _ra_,'. , ,I A IOWA Crilninal Histor Record Check Results As of _� // %(p a search Of the provided name and date of birth 13 No Iowa Criminal History Record found with DCI Iowa Criminal History Record attached, DCI # 9$5c+ Tag DCI initiais�— uC1-77 (08125110)--- Received Time Mar. 14. 2016 11:33AM No. 9598 t;.:., oc -"O cra Var.17. 2016 11,03AM Div of Criminal investigation No. 9617 P, 2/3 IOWA CRIMINAL HISTORY DCI 00859559 MISDEMEANOR CONVICTIONS ONLY PAGE I OF 1 DATE PRINTED- DCI:00859559 2016/03/17 NAME; CARTER,LEROY ONELL DOB SEX RAC HGT WOT EYE HAIR SKU POB 19870117 M B 510 160 BRO BLK DRK IL ADDITIONAL IDENTIFIERS PHOTO AVAILAELE: Y TAT R SMLD CCH RECORD **f Ol ARRESTED 20090305 AGENCY: XA0520100 CORALVILLE PD CHARGE NO- OS IA STATUTE IA124.402(5) POSSESSION OF A CONTROLLED SUBSTANCE TRK#: IA006AOOI CHARGE NO- 02 IA STATUTE IA719,3 PREVENT APPREHENSION/ OBSTRUCT PROSECUTION TRK#: IA006AO02 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA719,1(1)A INTERFERENCE W/OFFICIAL ACTS COURT CASE ID: 06521 AGCROB6364 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#7 1A006A001 SENTENCE DISP EFF DAT FINE $250 20110406 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA124, 401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 AGCROS6364 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A006A002 LICENSE REVOKED SENTENCE DISP EFF DAT TIME SERVED 14D 20110406 JAIL 14D 20110406 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 - EASED ON INFORMATION FURNISHED, WE CANNOT CONFIRM OR DENY THAT THE RECORD - COVERS THE SUBJECT OF YOUR INQUIRY." DIVISION OF CRIMINAL INVESTIGATION Ae �1 0 Iowa Department of Transportation CAO Cxaticr; cd Dry ScFwcr-- 4,1c�1 FT°e) 5,3211;21 P0 Box±i2p#. Des, Manes, !A3ChSIf 51 :s4 9123 1W' 51x+.239 1837 Convictions Citation Date Certified Abstract of Driving Record ACD Inquiry Date: 3/21/2016 DL/ID #: 187AD3343(IA) Customer #: 5328186 Name: Carter, Le Roy Onell Class: D ID Status: VAL Address: 2438 NEVADA AVE Audit #: 9355219 DL Status: VAL Conviction Issue Date: 08/20/2015 CDL Status: None City/State: IOWA CIN, IA Expiration Date: 03/17/2017 CDL Cert Status: None Suspended, Denied, 522406754 Cancelled, Revoked Endorsements: 3 CDL Med Status: None Mailing Address: 2438 NEVADA AVE Restrictions: NONE Restriction None Driving While Johnson IA Supplement: Suspended, Denied, Date of Birth: 3/17/1987 Mailing IOWA CITY, IA Sex: M 07/29/2015 IS92 City/State: 522406754 IA History Information Convictions Citation Date Conviction Date ACD Explanation County JUR JUR Revoked 03/21/2012 09/16/2012 A33 Drug/Drug 03/14/2009 04/06/2011 A33 Drug/Drug Related Johnson IA Related Conviction 06/04/2010 07/16/2010 620 Driving While Suspended IN 04/25/2013 D53 Non -Payment of Suspended, Denied, Cancelled, Revoked 08/17/2012 11/15/2012 B20 Driving While Johnson IA Suspended, Denied, Cancelled Revoked 06/24/2015 07/29/2015 IS92 Seed Johnson IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked 03/21/2012 09/16/2012 A33 Drug/Drug 1A 4A Related Conviction Suspended 02/01/2013 04/25/2013 D53 Non -Payment of IA Iowa Fine Name: Carter, Le Ray Drell DL/ID: 187AD3343 F 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 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 he set upon this document, at Ankeny, Iowa this date: jW[LLf --!kj 3/21/2016 IOWA t 114 Office Office of Driver Services Iowa Department of Transporation Name: Carter, Le Roy Onell DL/ID: 187AD3343 C)