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HomeMy WebLinkAbout16-100� r ANN—no l m� CITY OF IOWA CITY IDENTIFICATION NO. [G—(00 (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) 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 (319) 356-5497 FAX _First Middle Last 1. Name(REQUIRED) lCfra cap( ,ct R,00,rt`C2n 2. Address (REQUIRED) 2N3u Asticr A't 3. Contact Information (REQUIRED) EmailTl�rfG•�r 4�i,�5a IGq 8 cu' cj( 1cA' I Cell Phone: (a�o�'SSCi q0� Y (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) O 1p I d .I a01 l b. Taxicab Business Name (REQUIRED) _ -T� l CCtb 5. Prior experience in transportation of passengers: I WorYcd for tNUMber 1 CCrto- G y'ec.i V z�s 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When Simpctina W t'th t2rcordc Gralv,tl 2014 (w 2 -<Dl 3 ert- r What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended ead Guil Other 7. Have you been arrested / charged with any traffic offenses in the last five years? ye. S Tvpe of offense Where When NO Icajcr,ce (oiil (Cva ,\lK 2olz What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other C i tztiYrtor-, 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? tl c5 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) 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) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number t�/� A T `j U 3 issued on 0 G I I xpiring on OCP / 211 1`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, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature ofApplicantjziy 411.1Zr7 Date (7S )� 1lP rva ##k*xxxxkxkkxxxxx*hk#x,xxxxxxxxxxkkxx*xxkkkkxkkk***********###.,.#,.�.#*#*#**# #_<,*###< _xxkx.xx<x ,xxxx,xkx.xkkx**x*xxx. .kxxx*kk STATE OF IOWA ) - COUNTY OF JOHNSON 1 Subscribed and sworn to before me by e r r0. C ' ` aS h s o on this M, day of Viw� l of b �C��f�wk4 the Stie of Iowa 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 4'0-(1201;7 1 1�� Signature of Police Chief 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. h �- ig0ture of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date GertJrAxIDRweADGEAPPL52o14emewed.DOC 03/2015 C4610WADOT t1iJi lt,t ii vt{ SMiARTEF t SUMPLE ` ! (USTC ',rrH Di�'��£ < i Cl .0 Cyv Office of Driver Services FO Box 92{14 i Das Moines. [A 5D306-9204 Pttone: 515-244-9124 1 80fl-532-1821 I Fax, 515-239-1837 "W �dot.gov Certified Abstract of Driving Record Inquiry Date: 5/10/2016 DL/ID #: 615AH5743 (IA) CDL Permit Class: None Customer #: 5997533 Class: D CDL Permit Issue None Date: Name: Robinson, Tierra Caprice Audit #: 8898358 CDL Permit None Expiration Date: Address: 2434 ASTER AVE Issue Date: 03/06/2015 CDL Permit None Endorsements: Expiration Date: 06/21/2017 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522406731 Endorsements: 3 ID Status: None Mailing 2434 ASTER AVE Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA 522406731 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 6/21/1992 CDL Cert Status: None Sex: F CDL Med Status: None History Information Convictions ci.6 Od ri Date Conviction Date ACD 6Xp1anat;on Count f JUR 12/17/2012 02/04/2013 B64 -No Insurance Card Johnson ;IA Name: Robinson, Tierra Caprice DL/ID: 615AH5743 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 be set upon this document, at Ankeny, Iowa this date: r:....... '4�� 5/10/2016 IOWA'�y" 3_ ;e� r it BRIVE� $�__ Office of Driver Services Iowa Department of Transportation Name: Robinson, Tierra Caprice DL/ID: 615AH5743 Ma y. 12. 2016 3:33PW Div of Criminal Investigation No. 5078 1: 1/2 Fro ii�..a �Y ,- i.. A_ .,.y .-1crk .....�__ �— ..__.___1 cs/10/201L ln:0L _399 ...__/O02 S A:TR OF' 10FV14 < DCI ACCOnnl Nwnber:._.. 'Y on_ Z±: 1 (if apylftnhlt) 'fo' Io,'%o Aivisiun of flour CHMIn216,ae5tigaEinn `support ()lacratials I3urcau, I" Cron: City 0f ImLa Ciy --- 215 Ir, 71° $tree( City Clarks Wict — hes nRohtes,lowa 50319 „4I0 Is. l4aslunton (51 a) n5-6066 ]otWe City, LA Sb240 Lm re ues(in�n I ,-ast]i'arne (n,ai,aa )� bi rt -01 }ate DP$irth (mai Ocval-ga Phone: _ 319-356-SO41 I thuja{ ©MaI6 D emale Ccpr;ce ii 7lYeY info t7t1nl1011; Wi(hou( a signed walVer from the subject of the request a complete crilninul hislory record may oat be releasable, per Code or rows, Chapter 692.2, For compete criminal history record in(ormatioo, as allox'ed by law, al)vays obtain a t,. laivev signature (roto the subject of the remie,t Waiver Release. 1 hereby give rcnnissian rot she atovc Asof__ ` 12 DCI may be released as allo,rod by Imv. (Waive Signature: search of the provided name and date of birth revealed; too Iowa Criminal 11ist0ry 12ecord found with D(A 1 ]uwa CI in)inal Histury Rtcurd atllaached, DU i{ UC] illititals :6'_" DC'1-77 (00/2.5/10) Receive6 lime h4ay, 10, 2016 1:57PM No 3691 Niay12. 2016 3:33?M Div cf Criminal investigatlor IA STATUTE XA715A,5 TAMPERINO WITH RECORDS - 1907 IOWA CRIMINAL HISTORY DCI 00995102 NON CONVICTION PAGE 1 OF 1 COUNT NO- 01 IA STATUTE: IA715A.5 TAMPERING WITH RECORDS DATE PRINTED - AGCR103933 CHARGE CLASS: NON CONVICTION 2015/05/12 DCI:00995102 RESTITUTION SENTENCE NAME: ROBINSON,TIERRA CAPRICE DISP EFF AAT DEFERRED JUDGEMENT $625 CIVIL PENALTY DOB SEX RAC HGT WGT EYE HAIR SKN POR 19920621 F B 504 212 BRO BLK IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 20131210 AGENCY: 1A0520100 CORALVILLE PP CHARGE NO- 01 IA STATUTE XA715A,5 TAMPERINO WITH RECORDS - 1907 TRK#: 1A00I5H01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA715A.5 TAMPERING WITH RECORDS COURT CASE ID: 06521 AGCR103933 CHARGE CLASS: NON CONVICTION TRK#+ SA00I5H01 RESTITUTION SENTENCE DISP EFF AAT DEFERRED JUDGEMENT $625 CIVIL PENALTY 20140407 PROBATION lY 20140401 UNSUPERVISED PROBATION, INFORMAL PROBATION REVIEW 11/1/14 DISCHARGED FROM 20160414 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 IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION '7 No. 5078 P. 21/2