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HomeMy WebLinkAbout16-154CITY OF IOWA CITY 410 East Washington Sheet Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) . IDENTIFICATION NO. f_ Q} (Office Use Only) TO u1gy". T01XI APPLICATION FOR TAXICAB 1 MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) Fail{rrc—ioio Long ,dotetlleI ae,.,guircrl"inforrnafionwill rested,'rldeardrajirfr.,"jPPlrcarr n Middle Last 2. Address (REOUIRE :D) _�S %o u4t RiSy�Rcl NE IJo-4l Li6y 7A SL35-4 3 Contact Information (REQUIRED) Email: �oa%a<-jet;s;eQ ;oru2. ec u Cell Phone: 1 -5by2 (Ali written communication sent via email) 4a. Chauffeur's License expiration date (RFQUIRI`-D) Z 'j I'zo'2-2 b. Taxicab Business Name (REQUIRED) _ &9 : ^' z:� rI 5. Prior experience intransportation ofpassengers: ,ZD09-Zt%!0 f~ V 4�r5 1Qx;� tf T P C b an�f [�I[CCl '17a5L1 . 2662,-')P03: !G n., Ccs.. .:o, ...,F r— - -- ib� k/.rnnn, 6. Have you ever been arrested I charged with any misdemeanors andlor felonies in this State or elsewhere?�� Tvoe of offense Where When I'o Ssac -F ` C� rtlTr� 5' yz(r„ 7-w", c 4�� ; 2 OZ'3 fl�aagc;Ac A6w" Ass.. What happened to the charge? (Circle one) Convicted DismissedDeferred Suspended Plead Guilty Other Have you been arrested! charged with any traffic offenses in the last five years?yv { Type of offense Where When S ICru k xwndff)-bkA$cn Lo Iz- 81 2(' ) O 5re T�hcSan i0 fVi4 II(Z� (y01 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? W l _ Tvne of offense Where When c:. f'.7-'. 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provge;therpame(I '- Nj DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATES CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF RIr91EW 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 certify that I have issued to me by the Iowa Departmert of Transoortation a valid Chauffeur's license number -21 3 XX 3? 32- issued on � b g iap xpiring on 51 zti /20 :-Z 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 ary and all records and documents relating to this application, and I further agree that, if authorization to be a taxicab criver 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 '; Date -7--j-7— -2- 1) k SH*t*kk*xi-kµhiki*i*kW*iwk**xsxR#+*##kt;fFR.itehiRpMkkk#*kF*kkt*3atr±NY4'±'w%'wµµiiii#µ#wk4*kk**kkkwwRF*Rtitht*WRks#**rtkwx-ffi"^:±*Whli k*#*xkxw.tx*www STATE OF IOWA J COUNTY OF JOHNSON J Sbscribe, and sworn to before me by Sln,r.� �} _ '-esg,e on this Z day of r o. r Lc I have reviewed this applicatinn, 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 cr welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration ate of hauff is li ense Signature olice Chie r designee p to 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. Signa of City Clerk or designee D to GTS k*R;MtRkkh*kkYW*tksµ##H***##*i Mai#k***hwM:*RRFRRRKRfihkfitkRktkhtk3kkkkkli#*#*kYk#hi*i#*tii%Yk*ktkA+k*#R4wRRRttit;***k W-ik�k}*; Hkk��W M#Rtxww Office Use Only ter, Approved application DCI report State certified driving record Website update - cn Cl WTMUR WMDGE PL92014,.W d.1300 QN2015 ]Lt .9. 2016 12:02PM Div of Criminal Invesksaiior No � 7094 f'. 1/2 a= ..... .... ......._ _.., �e,........._ ,,::]O ,F6yU r.uu 2i oo2 STATE OF IGWA Criminal History Rec€.rd Check Request Form To: lows Ilivlslon of Crindnai )nveetigatiou support Operations 11oraau, 1" Floor 215 a, 71n Street Iles Moines, lova 50319 (5 Is) 7234066 (515)725-6090 Fax 1 al'p tonuenbl¢ an Town Criminal rXi cion. 12nrnr.! DCI Account 1`tum6cr: _ �{ ooh,: � (iia�,piiLdble) T+rom: City of loava G'1ly City Cierk's Offl4u — 4l0 ri.'lVwnngton Slrcel law&Chv, rA 42240 _ Phone: 319-3565041 paxo 319.356-44.97 Last Name (mandaloq') Firs[ INA371C Imandaloryj [Middle Name {reroinmend dl Te55e Tko m^4S Dear% Date of Birth (mandalc y) Gender tmsnea,o y) Social Securi Number (re<o ,manaeEy O S I zY 1298 Bh2ale OFemale WAiverInforrntANnn: Withow a signed walver n'am the subject ort lit request, a eompleta criminal history record may nol be releasable, per Code of Iowa, Chapter 692.2. Sol. complete criminal history record Sntormation, as allowed h}' laq, ahvays oblaln a watvor si ne(ul'e Isom the sub ee(of the re uosl. irr(liVdl' i�2IERSE: I hereny give permisria, fw she abare raGlRSling oRCial is condael ui l own crimlml llislorYraoctd check wish Inc Division cf [ruminal hwtsliptim (DCI)- any erlminal hislory Osla wnaerniog me (Wis is maintained by die DCl nus' be ¢leased es odowxd by lA, RrAivCl'SleltAfN1'C:^, �L o -II-�'--w.�+A ��w..vau r.uca.p ncJullS -:; IUCd'Asa u^,1y) As or "�.I�9 1� e search of the provided nalno and date of birth revealed: '- —' ='' •- N N © iso Inxa Criminal ldismr} Record found with DO -1P i lura Criminal History Record allached, D(.1 fi (DC( 0i vp - ,;le_: L--� DC1 ilaitialSAx—_ DC) -77 (09/25/10)�y- 3 Received Time Feb. 17. 2016 10:27AM No M1 F,P 19. 2016 12:0;?M Div of C,iminaI lnves'(Igation N D . 7 9 9 4 F. 2/2 UCI:D0691016 NAME: JESSE,THOMAS DEAN DOB SEX RAC 19640524 M N IOWA CRIMINAL HISTORY DCI 00691016 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF I DATE PAI4TED- 2016/02/19 HOT WGT EYE HAIR EKN POD 511 1.50 BLV BRO FAR IA ADDITIONAL IDENTIFIERS PHUTO AVAILABLE: Y CCH RECORD •** 01 ARRESTED 20030130 AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE ND- 01 IP. STATUTE IA124-401(5) POSSESSION OF CONTROLLED SUBSTANCE TRK#: 100775301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCRO64550 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 7,00776302 LICENSE REVOKED SENTENCE JAIL 2D FINE $250 02 ARRESTED 2013061.2 AGENCY: IA0520EDO NORTH LIBERTY PD CHARGE NO- 01 IA STA'IDTE IA7C6.2A(2)(A DOMESTIC ABUSE ASSAULT TRK#: 1A00GX7D1 COURT DISPOSITION AGENCY: IAO52015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: TA706.2A(2)(A) DOMESTIC ABUSE ASSAULT COURT CASE ID: 06521 SMSM094654 TRKp: IA000X701 SENTENCE DEFERRED JUDGEMENT CIVIL PENALTY $100 PROBATION 6M COMMUNITY SERVICE 25H W/I 90 DAYS 01SP kVY DAT 20030311 20030711 DISP EFF DAT 20130724 20130725 20130724 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 riv AN IIUWADOT .� SMARTER 3 FiMV !"? t Q� L'°� 'A , DR; t H SrVW,tt�V1t8dQ� gQV �rraaw.wri.rrxw,awx.;,wr,,.�,:rza.�, Office of Or Mal Services PO Box 4204 1 Des Moines. IA 50306.9204 Phone: 535-244-'31241 804532-7121 I Fa 515-230-1837 www.imaQot.gov Certified Abstract of Driving Record IntluI ry Date: 2/11/2016 OVID #: 713XX3332 (1A) CDL Permit Class; None c. Customer #: 1404129 Class: D CDL Permit Issue None 4Office Date: of Driver Services__( Name: Jesse, Thomas Dean Audit #: 8208775 CDL Permit None „y Name: Jesse, Thomas Dean DL/ID: 713XX3332 cA Expiration Date: Address: 3835 LOCUST RIDGE RD Issue Date: 06/27/2014 CDL Permit None Endorsements: Expiration Date: 05/24/2022 CDL Permit None Restrictions: City/State: NORTH LIBERTY, IA Endorsements: 3 ID Status: None 523179518 Mailing 3835 LOCUST RIDGE RD Restrictions: Corrective Lenses DL Status: VAL Address: Restriction None CDL Status: None Mailing NORTht LIBERTY, IA Supplement: CDL Permit Status: EEG City/State: 523179518 Date of Birth: 5/24/1984 COL Cert Status: None Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation t"ounty 3i1,R 12/08/2010 02/23/2011 .592 :Speed (10 mph & under in 35-55 mph zone) Johnson -IA 11/29/2014 01/12/2015 :592 (Speed Johnson IA 11/29/2014 04/10/2015 S92 5peed - MO Name: Jesse, Thomas Dean DL/ID: 713XX3332 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of office of Driver Services, Iowa Department of Transportation, do hereby certify that 1 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 T have been authorized by the Director of the Iowa Department of Transportation to so certify. In witness whereof, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: _ 4, 'sic" h,( M c.�OQ`.. 2/1;/2016 c. ,,1l11�8!(. 4Office thrrord= of Driver Services__( Iowa Department of Transportation - „y Name: Jesse, Thomas Dean DL/ID: 713XX3332 cA