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Home My WebLink About16-206Q�G®d1� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 5 2240-1 82 6 (319) 356-SO40 (319)356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. I (i- a 0 ( (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 3. Contact Information (REQUIRED) Email: o ,iw %3 hx - Cell Phone: 2l9--4�fi-Lj 2P? (All written com unication sent' is email) 4a. Driver's License expiration date (REQUIRED) [ �3 NN 5 n I n/ I b/?c1 lo b. Taxicab Business Name (REQUIRED) 1..1 Prior experience in transportation of pa cllS l-. Mme { J0. r - =te, C. 1� qP. 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? --rA Type of offense TFAA S Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred SuspendedPlead Guil 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? A A-) 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) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify, that I have issued to me by the Iowa Department of Transportation a valid Driver's license number %\33`l 5n3 issued on (gZVol-jjiaexpiring on 10/I%0120ib . 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 of Applicant ! 1GT.r(' ,. - Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by +P.V r on this Ko� day of 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 Driver's license/ A 12, / V Signature of olice 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. 14- SigtWure of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date C4erkNA%IDRIVBADGEAPPL92014a ded.DOC 07/2016 09,Sep. 14. 20160 4;30PMCeb Div of Criminal Investigation (FAX)3193382;N 0. 3012 STATE OF IOWACriminal History Record CheckRequest Tol Iowa Dlvlelon orCrlminal investigation Support Oparatlons Bureau, l" Floor 215 It, 7'h Street lies Molnes, Iowa 50319 (SI5) 725.6066 (518)725-6080 Fax I am remteatlno an InWA rAM:..o114:nr..v.. ue,....a rs....t....., P, 2/21002 DCT Account Number. _•9967-F " (Irepplleable) From) Yellow Cab ofiowa Cl P.O. Box 428 Iowa City, U. 52244 Phone: (319) 338-9777 Faxl (319) 339.7302 )Leet Noma ntbndale FirstNatne (mandolo Middle Name (rcwmmandad )4o Date of Birth mandato I Gender mandam 'Social•Seeurl Number raaommonds I J?e_ zMale ❑Female '•'j 7P. --1f c'7v6 WalverAlbrmaflom, Without a signed waiver from the subject of the regpest,a cam plots criminal history record may no be releasable, per Code of 10Wa, Chapter 692.2. For Comnlate trim Ina I hlstoryrocord Information, as allowed by law, always obtain a waiver signature, from the subject of the request, Waiver Release; I heroby give yemtllslon Ibr the above requesting otnolal to conduct an Iowa criminal history record check with the Division ofCrlminel Invasdgadon (DCO. Any orlmiaal hitter/ data eonaeraing me that Is matntsldod by the DCI may be rclaasod w atlowail bylaw. Waiver Signafuret (DCI use only) As of "f 1 �� , a search of the provided name and date of birth revealed: No Iowa Criminal History P aeord found with DCT ; r Iowa Criminal History Record attached, DCI DCI initials DCI -77 (08/25/10) Received Time Sep, 1. 2016 12:12PM No.3456 Iowa Department of Transportation 0 Office of Dauer Sermes (Toll Ffee) 800-5321121 PO Box 9204, Des Manes, 0 5030t J204 515-244-9124 FA)C 515239-1837 CLEAR DRIVING RECORD Name: Hogue, Joshua Nicholas DL/ID: 713YY5828 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Directdr 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: WWI Ll, � 9/7/2016 IOWA : bi D. 0. T. IIRti S�ry Office of Driver Services NMF N Iowa Department of Transporation Name: Hogue, Joshua Nicholas DL/ID: 713YY5828 Certified Abstract of Driving Record Inquiry Date: 9/7/2016 DL/ID #: 713YY5828 (IA) Customer #: 5009107 Name: Hogue,Joshua Class: C ID Status: None Nicholas Address: 422 N STEWART ST Audit #: 1148407 DL Status: VAL Issue Date: 07/13/2016 CDL Status: None City/State: NORTH LIBERTY, IA Expiration Date: 02/12/2021 CDL Cert Status: None 523179777 Endorsements: NONE CDL Med Status: None Mailing Address: 422 N STEWART ST Restrictions: NONE Restriction None Supplement: Date of Birth: 2/12/1988 Mallin NORTH LIBERTY, IA Sex: M City/State: 523179777 History Information CLEAR DRIVING RECORD Name: Hogue, Joshua Nicholas DL/ID: 713YY5828 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Directdr 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: WWI Ll, � 9/7/2016 IOWA : bi D. 0. T. IIRti S�ry Office of Driver Services NMF N Iowa Department of Transporation Name: Hogue, Joshua Nicholas DL/ID: 713YY5828