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Home My WebLink About16-239I CITY OF IOWA CITY 410 East Washington SIreel Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) . 2. Address (REQUIRED) IDENTIFICATION NO. LJ"� (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: 4a. Driver's License expiration date (REQL b. Taxicab Business Name (REQUIRED) L UAII written communication sent via emaill 5. Prior experience in transportation of passengers: 1 Q- A/ -P j FAAA 2 V R --L tom). N\ f- 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Tvoe of offense Where When What happened to the charge? (Circle one) i m IiCi 2 MR f*�rY Convicted Dismissed Deferre� Suspended lead Guilty Other Have you been arrested / charged with any traffic o enses in the last five years? l Ylpd tY� V\I r Type of offense Where When I nA arty✓ Lhe� P g`r N0L(QXvye— �2-0 1 S h ha ed 4o a cha e . (/�i Conv tBd WSAsed Deferred Suspended Plead Guilty Other ilax3LT 8! Has your driver's license or chauffeur's license been suspended or revoked in the last five years? LL) 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) NJC) a DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERtiFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF RI3VIEW 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 to me by the Iowa Department nofTransportation a valid Driver's license number (� � issued on exp irin on I understand that lf I falsely answer any questions in this application, that this application may be denied. I agree a 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 Applicac--_-�,Q/�Ca_) Date �� 2-0, l STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by et 5 i r C S o -k tiA on this Z n day of !'l . i r t. n C- 7 I,.%/( e 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 Driver's license// /5/ -O q Signature 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. 1� - /WIA Sign ture of City Clerk or designee Date r.a c> Office Use Only c'r Approved application —i,`.. DCI report State certified driving record Website update Clerk/rAXIDRIVBADGEAPPL92014em ded.DOC 07/2016 ve,I iv evi wi I. L/nm viv vi vi inti nai to v cat 1 6 a L ion 1110-7/43 r, I/7 Ffo....-"., _� .- i _..r Jl ork--....-_ -.- 10/00/2016 16;06 ,709 r...�/002 I STATE OF IOWA Criminal History Record Chea Request Form To: Iowa Division or Criminal htvesligatton Support Operations Bureau, itt Floor 235 E. 71h street 11es Moines, Iowa 5031.9 (515) 725-6066 (515) 725.6000 Fax L-� , Vr V rL DQ Account J iniber; y PLP (ifs~ 07noept¢) -- From;L'a. 'tY' Of Iowa City City Cleric's Office ---'- 410 D. Washington Shyest liowa Cit , IA 52240 Phone; 319-356-5041 Fax: 319-356-5497 ❑Malt Female I ��2 S2�� rfir ver rn/o>ytrrfiou; Without a signed waiver from thb subject oft he request, a complale criminal history record may not be releasable, per Code of Iowa, Chapter 692.2• For earn ete erimisat hlsror}' record complete rim as allowed re ord always Main a waiver si namro from Ulesub'eet of there nest.Inly, Waiper Aljefeass:I hereby givaputnisstoa farlltc above regoesting oKctal to wnduct an Iwvn criminal h,vesdgnfion roen. AMY Mminal history dsta conceming me that is mainleined , histo by dt 1)CCmoy he rtleased as allot a record chetk with die lY � • �� n rveionofCriminal WaiverSYrnafwe• � /Y—N Cly ��Y1 (Ucl ase caly) As of o ..�0 - a see'rch of (he provided name and date of birth rmyealed: ❑ No Iowa Criminal Hislory Record found with 1)CI - I Iowa Criminal Ilistoty Record atlached,l)CI_� Qj� ZgC3Q t ; LN AC1 initials—� T Received Time Oct. 6. 2016 2:54PM No. 4635 Oct.10. 2016 11:25AM Div of Criminal Investigation ADDITIONAL IDENTIPIERS TAT CHEST TAT L FOOT TAT L WRS TAT L WRST TAT LF ARM TAT NECK TAT R ANKL TAT R FOOT TAT R THGH TAT RF ARM TAT UL ARM TAT UR ARM 01 ARRESTED 20060012 PHOTO AVAILABLE: Y CCH RECORD *** AGENCY: IA0520500 NORTH LIBERTY PD CHARGE NO- 01 IA STATUTE IA124.401(5) POSSESS CONTROLLED SUBSTANCE TRK#: 101941101 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 SRCRO76832 CHARGE CLASS: NON CONVICTION TRK#: 101941101 SENTENCE DEFERRED JUDGEMENT PROBATION lY DISCHARGED FROM DEFERRED JUDGEMENT 02 ARRESTED 20120722 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE TRK#: 1A00ES701 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.414 POSSESSION OF DRUG PARAPHERNALIA COURT CASE ID: 06521 SRCRO98807 CHARGE CLASS: MISDEMEANOR CONVICTION No, 5743 P. 2/5 DISP EFP DAT APPEAL DATE 20061129 20061129 20070529 20070502 IOWA CRIMINAL HISTORY DCI 00782950 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2016/10/10 DCI:00782950 NAME: HESSELTINE,JESSICA LYNN 9MITH,JESSICA LYNN DOE SEX RAC HGT WGT EYE HAIR SKN POB 19821105 F W 506 195 BRO BRO IA ADDITIONAL IDENTIPIERS TAT CHEST TAT L FOOT TAT L WRS TAT L WRST TAT LF ARM TAT NECK TAT R ANKL TAT R FOOT TAT R THGH TAT RF ARM TAT UL ARM TAT UR ARM 01 ARRESTED 20060012 PHOTO AVAILABLE: Y CCH RECORD *** AGENCY: IA0520500 NORTH LIBERTY PD CHARGE NO- 01 IA STATUTE IA124.401(5) POSSESS CONTROLLED SUBSTANCE TRK#: 101941101 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 SRCRO76832 CHARGE CLASS: NON CONVICTION TRK#: 101941101 SENTENCE DEFERRED JUDGEMENT PROBATION lY DISCHARGED FROM DEFERRED JUDGEMENT 02 ARRESTED 20120722 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE TRK#: 1A00ES701 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.414 POSSESSION OF DRUG PARAPHERNALIA COURT CASE ID: 06521 SRCRO98807 CHARGE CLASS: MISDEMEANOR CONVICTION No, 5743 P. 2/5 DISP EFP DAT APPEAL DATE 20061129 20061129 20070529 20070502 UCI. IV. [UID II:LOHIVI ulv of urlminai investigation No. :)/It) r. 7/7 DCI 00762950 PAGE 2 OF 2 TRK#: 1AOOES701 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EPP IIAT :TAIL 2D 20121203 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 PCI. 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 SUB.7ECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION Iowa Department of Transportation Inquiry Date: Name: Address: City/State: Mailing Address: Mailing City/State: Convictions Certified Abstract of Driving Record 10/11/2016 DL/ID #: Smith, Jessica Lynn Class: 305 S CENTER ST Audit #: 9050413 Issue Date: LONE TREE, IA Expiration Date: 52755 None 11/05/2018 Endorsements: PO BOX 593 Restrictions: 713XX3757 (IA) Customer #: 3007526 D ID Status: None 9050413 DL Status: VAL 05/01/2015 CDL Status: None 11/05/2018 CDL Cert Status: None 3 CDL Med Status: None Corrective Lenses Restriction None Speed (10 mph & Supplement: IA Date of Birth: 11/5/1982 LONE TREE, IA Sex: F 527550593 History Information Citation Date Conviction Date ACD Explanation County JUR 01/17/2016 02/04/2016 M42 Improper Lane Johnson IA (changing lanes 02/10/2016 03/07/2016 S92 Speed (10 mph & Johnson IA under In 35-55 mph zone Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Smith, Jessica Lynn DL/ID: 713XX3757 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: Name: Smith, Jessica Lynn DL/ID: 713XX3757 10/11/2016 Office of Driver Services Iowa Department of Transporation Y