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HomeMy WebLinkAbout16-076Ib »ul ,;Jzr � �. CITY OF IOWA CITY 410 East Washington Street Iowa Cily, Iowa 52 240-1 826 (3 19) 356-5040 (3 191 356-5497 FAX 1. Name (REQUIRED) - 2. Address (REQUIRED) IDENTIFICATION NO.. J 6 _ 071 W (Office Use Only) a lI/1 l9 1 wc2 k --47//y APPLICATION FOR TAXICAB / MOTORIZED PEDICA@ VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) E a! Gem L �� t �rcte (bq "CeFf Ed4'f eet s ifUF'Fitar f1 } d"jj( t SFlii: f6t CF -ilia'Ct7 �dc e(7�.)tlOdf/II, t First Middle Last r fin.? Z6% 1/19r, C- 3 3. Contact Information (REQUIRED) Email: 4a. Chauffeur's License expiration date (RFOUIREE b. Taxicab Business Name (REQUIRED) _ —. 5. Prior experience in transportation of passengers: Cell Phone: 3/7'Y,-/' 711 o 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where 1--1j, LATS [C�iV:t"-Ir•;V n-1-' ��.�l:rr/ When What happened to the charge? (Circle one) f_ CConvicte ) Dismissed Deferred Suspende Plead Guil Other 7. Have you been arrested/ charged with any traffic offenses in the last five ve What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended ( Plead Guilty) Other 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When 9. Have you��er applied to be an Iowa City taxi driver using a different name? If yes, please provide the names) 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 cert that I have issued to me by the Iowa Deparim nt of Transportation a vali Chauffeur's license number 5 issued on �/� �j'� expiring on 4 r c, I understand that if I falsely answer any questions in this application, that this applica ion 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 app(ie ticy, at bf iAher agree h t, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisioM TF td S;,C�rBp1e - [he C� Code. (Needs 4o be signed in front of a Notary Public) _ 'tea Signature of Applicant l.- Date _/ Z �1 1' STATE OF IOWA ) COUNTY OF JOHNSON ubscribednd sworn to before me by CYIcd�AYJ I Cid 1� a rl_ r- ICK on this 12opM1:)�,f- --'-)t-)I:;- 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 Cod/e). Expiration date of Chauffeur's license Z x Signature- of Po ce Ohief or designee /Z -Z,11! 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. t;lgnabne of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Clerk✓TAXIDRveaocEAPar92014amended.DOC 0312015 ate Clerk✓TAXIDRveaocEAPar92014amended.DOC 0312015 �De1.30• 2015 10:28AM Div of Criminal Investigation From:Clty of Iowa City Clerk Olflee 319 3665497 am No. 4297 P. 1/2 12/29/2016 10;54 WnEG P.002/002 STATE Or' IOWA J 00 Cl-imirlal History Record Cheek _ ✓ Request ;l+orris 9 'fb: 111%va Division of"(Jrimin9l Inve0igmion Support 0peraticris Bureau, )"Floor 215 n. 91° street DesMoines,lowa 50319 (515)725-6066 (515) 725-600 Fax C! c on: D(-') Account Number: (ifappliwhlc) From: Cit � of lotus Cit City Clerk's Office 410 E, Washington Street Iowa City, 1n 52240 Phone: 319-3565041 Fax: 319-3S6-5497 Middle Name (recon 114e? /t> (J4` )� J.l v Tale ©Femora 26, `76 `� 7 �, j 13 airel-Xnformafiolf: Without a signed waiver f ,om the subject of the request, a complete criminal history record stay not be releasable, per Code of lows, Chapter 692.2, For complete criminal history record Information, as allowed by law, always DUlahl a Waiver slenetul'e hom fhe uthieM nrf6n .e...e,.t bjrgiver•tele(M:IhtrchygiVcpoll issionfaruea���� dl Otons bcr' for Ord checkrefr n h wthyision cfcri,linal Inf4.ligalion (DCI). Any criminal history data Cout2niia nl is ai oedh S 8y be rel atd�as wed by law. WoiverSignafure I air a a 41 , . i✓ Iowa (Criminal History Itecord,Check Results (aclen1j) As of t at 301 a search of the provided name and date of birth revealed: No lo�r'e Criminal History Record found wit), DC1 Iowa Criminal 1-iislory Record attached, DC) #_ O� (0.4 x'• - DO inilialsl_ a�a.a-n tuol4.;11v) Received Time f)ec. A Mli 9 41AM No 4110 Dec. 30. 2015 10:280 D1 v of CiiminaI Investigation IOWA CRIMINAL HISTORY DCS 00507646 FELONY CONVICTION PAGE 1 OF 1 DATE PRINTED- DCT:00507646 2015/12/30 NAME: HAMRICK,CHAD HAMRICK,CHADWICK AARON DOB SEX RAC HOT WGT EYE HAIR SKN POE 19770411 M W 506 165 BRO BLK LGT IA ADDITIONAL IDENTIFIERS CCH RECORD +** 01 ARRSST13D 19950916 A08NOY: IA0920000 WASHINGTON CO SO CHARGE NO- 02 IA STATUTE IA708-7 HARASSMENT TRK#: 022450902 COURT DISPOSITION AGENCY: IA092015J WASHINGTON CO DIST COURT COUNT NO- 02 IA STATUTE: IA708-7 HARASSMENT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 022450902 SENTENCE DISP EPP DAT FINE $100 19961024 02 ARRESTED 19980902 AGENCY; IA0520200 IOWA CITY PD CHARGE NO. 01 IA STATUTE IA713-6 ATTEMPT BURGLARY 2ND DEC TRK#: 037241001 COURT DISPOSITION AGENCY: IA052016J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA713-6(2) ATTEMPT BURGLARY 2ND DEC CHARGE CLAS5: FELONY CONVICTION TRH#: 037241001 SENTENCE DISP EFF DAT COURT COSTS 19990226 PROBATION 2Y 19990226 SUSPENDED SY 19990226 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 HUT CAN ONLY BE RELEASED TO NON -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. QD�IVISION OF CRIMINAL INVESTIGATION ly �o4297 f. 2/2 Inquiry Date: Customer Name: Address: Page 1 of 2 q . s r WM i 1Jytcei: atigov �h4ki;TFP, i SIP�h t=f� 1iU>Tfi,11F�, fti4U��e,�.-.ham„ �.'�l9Ci - Office of Driver Services PO Box 9204 ; Des Moines. IA 50306-9204 Phore:. 515-244-9124 1800-532-1 12l I Fay.: 515-239-1837 www.iawadoLgov Certified Abstract of Driving Record 12/29/2015 DL/ID #: 769YY2955(IA) CDL Permit Class: None 2349835 Class: D Hamrick, Chadwick Audit #: 7661903 Aaron 2518 INDIGO DR Issue Date: 01/02/2014 City/State: IOWA CITY, IA Convictions Expiration 04/11/2022 Date: Endorsements: 3 CDL Permit Issue None Date: CDL Permit 522406808 Mailing 2518 INDIGO DR Address: None Mailing IOWA CITY, IA City/State: 522406808 Date of 4/11/1977 Birth: None Sex: ti Convictions Expiration 04/11/2022 Date: Endorsements: 3 CDL Permit Issue None Date: CDL Permit None Expiration Date: Restriction None CDL Permit None Endorsements: 02/03/2015 CDL Permit None Restrictions: ELG ID Status: None Restrictions: NONE OL Status: VAL Restriction None CDL Status: None Supplement: 02/03/2015 M14 Fail to Obey Traffic Sign/Signal CDL Permit ELG Status: CDL Cert Status: None COL Med btatus: None History Information Citation Date Conviction Date ACD Explanation County IUR 01/05/2015 02/03/2015 M14 Fail to Obey Traffic Sign/Signal lohnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number IUR 06/07/2014 802293 IA 08/20/2014 813321 IA Name: Hamrick, Chadwick Aaron DL/ID: 769YY2955 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: 12/29/2015 12/29/2015 Office of Driver Services Iowa Department of Transportation Name: Hamrick, Chadwick Aaron DL/ID: 769YY2955 Page 2 of 2 12/29/2015