HomeMy WebLinkAbout16-080CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name (REQUIRED) _
2. Address (REQUIRED)
IDENTIFICATION NO. i b -L�j
(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
3. Contact Information (REQUIRED) Email:
Ak
written
U� �Last
A�c
�P'h A r,,� CC'he
Phone:
sent via emaill
4a. Chauffeur's License expiration date (REQUIRED) 10 -3t- d-ol 10
b. Taxicab Business Name (REQUIRED) _ li�t
5. Prior experience in transportation of passengers:
66 C{ -34z.`1
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? 7 "
Where
F
When
tF r h it9A If (el
What happened to the charge? (Circle one) 11
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
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 years? �jjo
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.ther ame(sT+
?,
tj
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED }
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIIEW
You must apply for an individual Department of Criminal Investigation Report (form available upon -.inquest).
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
n
02/2015
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I herebyfce�rt�fy that I h�e� issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
11 JJ II b Cl issued on 11- I expiring on 10- - to . 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 ore ployees of the City of Iowa City, Iowa, in their discretion, to examine any and all records and
documents relating to this lication, and I further agree that, if authorization to be a taxicab driver is granted, to comply at all
times with all of the provisjonl,of Title 5, Chapt@r 2,,&�e Cjty-Ep*. (Needs to be signed in front of a Notary Public)
STATE OF IOWA )
COUNTYOFJOHNSON )
Subscribed and sworn to before me by
✓�� DateeL
/_ �s
on this l\ 4tN day of
in and for the State 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 Id
L�_ C(/ / �l ((C Cil
Signature of Polc ief 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.
Signat of City Clerk or designee
Bio/G
p to
Office Use Only
r
Approved application
DCI report
State certified driving record {
Website update
aerwraeioaivenDGr PPL92014amended.DDc 0312015
2ultlo1i:49HM )iv of Criminal investigation No. 1228 P 3/7
_�� .-arr' Gl qin .,,,.,..0 uio ,ursu�o. 04 /06/20Y6 Y6.c� rlGbu-uJ2/Op'a
STATE OF IOWA
Criminal ffisto)ry T cC()j-d Che(..k
Regtlest Forklift
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1XI AccountNumher: efe)p z - —F
To:lu W
a fliviainn of C'rimhral )nvcEligation
SuPP011 01i Bur-eau,I"Floor From: q!xoelowaCity
215 E, 7'h Strec[ City CICrh's OfQcC �— --
Ues Molnes, tows 503[9 4101;• Washtrleton &Inset
(515) 725-6066 ---------
(315) 725-6090 Far lows CMA 62240
Pbonc: 319.356-3041
Fat; 319319-35��
l aIn re uestin an lowa Criminol Histol Record Check on:
Last Name ()amatory) -First Name tn,andalory)
Middlei�alne (recommend�Y
hate of Bil-th (mandamq') Gender
(mandatory) social Securil.
n, •J Numller stc0lnmcndei
—rV —3 t L 7O a� Male ❑Female ' I --7D-0 i 7q
WRtV¢r litfo/•ntnfia/t:1Vi(hout a signed waiver from the subject of the request, a complete criminal
per Code Of Lown, Chapter 692.2• For Nslory record may net
obtain a waiver
be releasable, ca- mnlete criminal his(m y record information, as atlorred re law, always
si nature from the sub ect f he re ass[.
Maive), R¢IC!/8¢: I hereby give permission for )M1
Invesli anion nC0 y S ( . An criminal Aislory-dala epncinhat is meint ' d b � I 1 ,ej+n) /leas �..
JOWa Criminal Histoll1i, Record Checic i3esrlIts
As of
r search of the provided mine and date of bitch revealed: a
❑ No Iona Criminal History Record found faith DC1
lou,a Climind Hislory Record attached, DO !{ Qr�
DCljn't' I -�
�— — Io s --
DCl-77 (08/25/10)
Received Time Apr. 5. 2016 3:08PM No. 1616
(uCi use on)y)
Wpr. 6. 2016 11 � 4 9 A M Div of CriTina? Investigation
IOWA CRIMINAL HISTORY
MISDEMEANOR CONVICTIONS ONLY
DCI:00706490
NAME: DAVIS,ERYANT L
RANDLE,GEMAYAL L
RANDLE,GEMAYAL RASHAUN
DOB SEX RAC HOT WGT
19810921 M B 601 165
19811021
19921031
DCT 00708490
PAGE 1 OF 2
DATE PRINTED -
2016/04/06
EYE HAIR SKN POE
PRO BLK DRK IL
ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y
Sr PHD
SC HEAD
CCH RECORD •++
01 ARRESTED 20031003
AGENCY: IA0520200
IOWA CITY PD
CHARGE NO- 01
IA STATUTE IA708-1
ASSAVLT ON PEACE OFFICER
TRK4: 100970407.
COURT DISPOSITION
AGENCY: IA0520I5J
JOHNSON CO DIST COURT
COUNT NO- 01
IA STATUTE: IA708.7 (4)
HARASSMENT / 3RD DEGREE - 1989
COURT CASE ID: 06521
SRCRO66636
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#: 100970401
SENTENCE
TIME SERVED
3D
JAIL
3D
02 ARRESTED 20050116
AGENCY: ZA0520200
IOWA CITY PD
CHARGE NO- 02
IA STATUTE IA714.2
THEFT 2ND
IRM 101404902
CHARGE NO- 03
IA STATUTE IA715A.6
CREDIT CARD F0908RY/JOINT/CRIMINAL
TRK#: 101404903
COURT DISPOSITION
AGENCY: IA052015J
JOHNSON CO DIST COURT
COUNT NO- 02
IA STATUTE: IA715A.6(2)-C
VNAUTHROIZED USE OF CREDIT CARD C $1,000
COURT CASE ID: 06521
VECR070622
CHARGE CLASS: MISDEMEANOR CONVICTION
TRKY! 1 014 0 4 9 02
RESTITUTION
SENTENCE
FINE
$500
COURT DISPOSITION
AGENCY:
DISP EPP DAT
20040116
20040116
DISP EFF DAT
20050909
No,1228 P. 4/7
n�
rr.
. Apr., 6, 2016 11,50AM Div of CI'ITInaI Investigation
DCI 00700490
PAGE 2 OF 2
IA052015J JOHNSON CO DIST COURT
COUNT NO- 03 IA STATUTE: IA714.2(3)
THEFT 3RD DEGREE - 1978
COURT CASE ID: 06521 FECR070822
CHARGE CLASS; MISDEMEANOR CONVICTION
TRK#: 101404903
SENTENCE DISP EFF DAT
FINE $500 20050908
03 ARRESTED 20090321
AGENCY: IA0520200 IOWA CITY PD
CHARGE NO- 01 IA STATUTE IA124,401(5)
POSSESSION OF A CONTROLLED SUBSTANCE
TRK#; IA006EXOI
COURT DISPOSITION
AGENCY: IA0520154y JOHNSON CO DIST COURT
COUNT NO- O1 IA STATUTE: IA124.401(5)
POSSESSION OF A CONTROLLED SUBSTANCE
COURT CASE ID: 06521 SRCR086579
CHARGE CLASS: NON CONVICTION
TRK#: IA906EX01
SUBSTANCE ABUSE EVALUATION
SENTENCE DISP EFF DAT
DEFERRED .7UDGLMPNT $315 CIVIL PENALTY, CLEAN 20090730
UA W/IN 10 DAYS AND/AS
ORDERED
PROBATION 1Y 20090730
UNSUPERVISED PROBATION TO
DCS
DISCHARGED FROM 20100727
DEFERRED JUDGEMENT
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 I5
BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD
COVERS THE SUBJECT OF YOUR INQUIRY,
DIVISION OF CRIMINAL INVESTIGATION
No -1226 P. 5/7
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