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Home My WebLink About16-233tt7� CITY OF IOWA CITY 4 10 East Washington Street Iowa City. Iowa 52 240-1 92 6 (317( 356-5040 43171356-5497 FAX IDENTIFICATION NO. ( ffice se Only) APPLICATION FOR TAXICAB I 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" infonnafion will result in denial of the application 1. Name (REQUIRED) ) / ( Ar 2. Address (REQUIRED) _ ! 1 57l r, 3. Contact Information (REQUIRtD) Email: ow 4a. Chauffeur's License expiration date (REQUIRED) Cb)Taxicab Business Name (REQUIRED) _ 5. Prior experience in transportation of passpagers: _ sent IM G. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? C I �jjrrl� Yri J� p LfI�lyG `% q 7 5� W t1Spp necRo a harge. (' eb ) /'Sl �, /�it:, 0 Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested t charged valh any traffic offenses in the last five years? G 23"33 C oil S" What happened to the 8. Has your driver's license or chauffeur's license been suspended or revoked in ladGuilty Other last five years?� Type of offense Where When 9. Have you ever applied to be an Iowa City taxi drivgr u25g a different name? If yes, please pt yr de th&;hame(s) /AV! rn „� DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTWIED F DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICEOHIEF REVIEV You must apply for an individual Department of Criminal Investigation Report (form available upon reglQst), (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 09[2015 /\ I APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I h r by c at I hav of me by the Iowa D pa me of Transportati n a-val hauffeur's license number J ti Cl i issued on expiring on�_ _. I understand that if falsely answer any questions in�tAis ap licahon, that this applicatto 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 "// 0 Cr \ Date }Yxf4}1Y}*x}x33mxixxHxtR*xhYSRx tirttxx*—x . xxx444443xYkxkShs fx:xxxxx.xY:Y#YYY3YY.;ba'f Yx YLxxxxil4YSYYx4#y!#%4:YYtY+4444}}}}}}}}}H}}}}}}}}}}} STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Sou w, �) qrn er Sh ra �(� on this day of elpry yr a0( �NQWy Public in and for the State of Iowa ****3*3#iii444443k134*i#3tf144**i:M44444#i*11444##i444kY433h44444444444644M4##444441kkt44444444#4414*44#4hil4li4Rit3/3443*34#*##4k#*ik#433t4NYt 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 n t 1r112a 11 Signature of Polic6 Chief or designee D2231� 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. Signal ily Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update -a.1-ice Date 1� CD W s Z7 5 _a .rve1 QaWTAxioRry DGWPL9=4ame D= 03/2015 Ftb 4 2016 10:41 AM Div of Criminal Investigation No. 6842 P. 1/3 021..-.'�..f:. 5--- Cab .. „ .1 (FAX)3183362,w, Criminal History Record Check STATE OF IOWA DCI Account Number 9967-F �' nr.pPnabll) To: lawn Division of CrimineI Investlgatlon yrom0 YalloW Cah of Iowa Clty suppo216 Z. 1h Street Bureau, P Floor P.O. Box q28 2t5E.7 Street • Dos Malnse, IOWA 50319 (915) 725-6066 Iowa City, IA. 82244 (515)'729.6000 Fax ' Phonor (319) 338.9777 , Fax. (3X9)339-7302 s oc veIla Dsto 0f Birth tmindam„n- r_o.,aa .---,-•_-... .,. . _.. _ _- - _ 0l->7-19��' aie ❑>,emale �- WalVeriii/ormillion. Without a signed waiver ham the Aubleot of the request, a Oomplgte ariminal hlstory roacrit may not be relenaoble, per Code of Iowa, Chapter 692.7. For cam plat criminnl historyrecord Information, ne allowed bylaw, a)wsye obtain a waiver slobemra n•nm Al. u._.....s.- ___..__. WaiparReleaSe. I botchy give permission Tor the sbo4e«quesdnge}netp to COMM M laxs atim1,.11lnorymord oh.oltwish the 1xM11on ofCrimind Ievatlgs110m(DCO, Anyerimtndhistorydatecopeemingme0111hmaltadnedbysheDClNlybeselaerodu•I1OW84by14W, Waiver Signahiral As of_ ?--Lt—( (' a ecarch of the provided name and data of birth revealed; No Iowa Criminal History Record (bund with DCI Iowe, Criminal History Record attached, DCI DCI initialed DCI -77 (08/25/10) Received Time Feb. 2, 2016 10!01AM No,6456 pool W. only) Feb, 4. 2016 10:41AM Div of Criminal Investigation No, 6642 P. 2/3 IOWA CRIMINAL HISTORY DCI 00166530 FELONY CONVICTION PAGE 1 OF 2 DATE PRINTED - 2016/02/04 DCI :00106530 NAME: SHROCK,STEVE , SHROCX, STEVEN WARNER DOR SRX RAC HGT WGT EYE HAIR SKN POD 19460117 M W 506 160 GRN BRO MED IA ADDITIONAL IDENTIFIERS SC L CHK CCH RECORD wi+ 01 ARRESTED 19721124 AGENCY: IA0770000 POLK CO SO CHARGE NO- 01 DANGEROUS DRUGS/POSSESSION OF CONTROLLED SUBSTANCE TRK#: L07373601 COURT DISPOSITION AGENCY: 14077015J POLK 00 DIST COURT COUNT NO- 01 IA STATUTE: DANGEROUS DRUGS/ POSSESSION/CONTROLLED SUBSTANCE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L073736D1 SENTENCE PLEAD GUILTY JAIL 1BOD 02 ARRESTED 19740430 AGENCY: IA0070300 WATERLOO PD CHARGE NO. 01 IA STATUTE IA204-401 DANGEROUS DRUGS/POSSESSION/CONTROLLED SUB/INTENT TO DELIVER TRK#: LD7373701 COURT DISPOSITION AGENCY: IA007015J BLACK HAWK CO DIST COURT COUNT NO- 01 YA STATUTE; POSSESSION/CONTROLLED SUBSTANCE WITH INTENT TO DELIVER CHARGE CLASS: PRLONY CONVICTION TRK#: L07373701 , SENTENCE DISP EFF OAT SUSPENDED PRISON SY 19751025 PROBATION 19751025 03 ARRESTED 19900722_ AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA236-12-2cc - Cp ASSAULT/CAUSING INJURY/ DOMESTIC ABUSE C'i •,{ n] "" TRK#: L07373BOI COURT DISPOBITION I. T• AGENCY: IA052015J JOHNSON CO DIST COURT r'; u {`'i COUNT NO- 01 IA STATUTE: IA236-12-2 ,.,. ASSAULT CAUSING INJURY yt: CHARGE CLASS: MISDEMEANOR CONVICTION Feb. 4. 2016 10:41AM Div of Criminal Investigation TRK#: L07373801 SUBSTANCE ABUSE EVALUATION SENTENCE PROEATION IY SUSPENDED 30D BATTERERIS EDU PROD DCI 00186530 PAGE 2 OF 2 Di$P EFF DAT 19901212 19901212 19901212 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 THR VCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFYCATION 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 No. 6842 P. 3/3 66 4ADOT t S ,AARTER i SPAPLER I CUSTOMEF DRAIER w�rnrv.iowadot.gov Office of Driver Services PO Bax 9244 1 Des Moines, IA 50303-92114 Phone_ 515-244-9124 i SB0-532-1121 I Far.: 515-239-1837 www.iowadot.gav Certified Abstract of Driving Record Inquiry Data: 2/23/2016 DL/ID A: 435AA5012 CIA) CDL Permit Class: None Customer 7f: 224854 Class: D CDL Permit Issue None IOWA Date: Name: Shrock, Steven Warner Audit cit: 6581207 CDL Permit None rw" .- Iowa Department of Transportatloii ; Expiration Date: Address: 4487 490TH ST SE Issue Date: 01/02/2013 CDL Permit None Endorsements: Expiration Date: 01/17/2018 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522408288 Endorsements: 3 ID Status: None Mailing 4487 490TH ST SE Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA 522408288 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 1/17/1945 CDL Cert Status: None Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date Explanation County 71In 01/31/201502/D3/2015 _ACD M14 _ ;Fail to Ohey Traffic Sign/Signal _ _ =Johnson 'IA Accidents - Accident involvement indicated does NOT mean the Individual was at fault or given a citation. dccident Date ... .... .... r8umber Caselull--.- .. _._.. ... .._ .. .... _._ 02/17/2012 ._ ...... .. ..:673587 _..,. ' ........... .._._...._.:II .. Name: Shrock, Steven Warner DL/ID: 435AA5O12 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 ropy 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: ti �ifKiti•u'p/`4� i�r �`� �......., :p 2/23/2016 IOWA D. 0. T. oE111E4f Office of Driver Services a� 1 rw" .- Iowa Department of Transportatloii ;