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HomeMy WebLinkAbout17-015� r CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 5 2240-1 82 6 (3 19) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. l- 'D1 S (Office Use Only) ( l APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHIGI' E DRIVER (Police Department review must be made between 8 a.m. to 3 p.m.,--4onday - Friday) Failure to complete the "required" information will result in 4wdal of the apalication 3. Contact Information (REQUIRED) Email: E108 C-1WIC.Q M060 id COM Cell Phone:'j1 3o Sof S � (All written com uniication,§gnt via email) 4a. Driver's License expiration date (REQUIRED) I aC /Coo zo b. Taxicab Business Name (REQUIRED) yAIW dh of ,14 -AA 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When What happened to the charge? (Circle Convicted ismissed Deferred Suspended Plead Guilty Other 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? 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 herebv1( certify -((h t have issued to me by the Iowa Department of Transportation a valid Driver's license number V� � b issued on rD/ %/ I p expiring on 11/,')o 1h. 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 gtarhted, to comply at all times with all of the provis' ns o Title Lapter2,of he City Code. (Needs to be signed in front of a Ni)tary Public) Signature of Applicant �� Date J F . STATE OF IOWA ) COUNTY OF JOHNSON ) (� Subscribed and sworn to before me by n this 3i�� day of Notary lic in and for the Sta f Iowa +r+rraaaaa+aar++rrr+rar+xra+aaaa arr++rrar«rrrr +r+.+rr.+++++«.+n,....+.. 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 dat of ri is license Uzi ail �� Signature f Police Chief or designee Dam 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. Si ur of City Cle k or deli nee Office Use Only Approved application DCI report State certified driving record Website update -\ A \—� \\ Date Gerk "IDRWII DG APPL92014amende DOC 07/2016 Iowa Department of Transportation i 0 ice of orrrff Servtces (Toll Free) 800.532.1121 PO BDx 92D4, Des Manes, (A 503W9204 515-244.9124 FAX: 515.2391837 Certified Abstract of Driving Record Inquiry Date: 1/19/2017 DL/ID #: 075BB3076(IA) Name: Schaapveld, Rachel Class: C Louise Address: 400 E JAYNE ST Audit #: 1037759 08/28/2014 D53 Issue Date: 05/27/2016 City/State: LONE TREE, IA Expiration Date: 12/20/2020 527557766 Suspended 03/15/2016 Endorsements: NONE Mailing Address: PO BOX 598 Restrictions: NONE Date of Birth: 12/20/1990 Mailing LONE TREE, IA Sex: F City/State: 527550598 History Information Sanctions Customer #: 4508852: ID Status: VAL ---­` DL Status: -VAL 7 CDL Status: - None i CDL Cert Status: - None CDL Med Status: None - Restriction None Supplement: - Type Effective End ACD Explanation Occurrence 3UR JUR Suspended 06/18/2014 08/28/2014 D53 Non -Payment of IA IA Iowa Fine Suspended 03/15/2016 05/22/2016 051 Non -Payment of IA IA Child Support Name: Schaapveld, Rachel Louise DL/ID: 075BB3076 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: 1/19/2017 ,D.0.T. � Iha•��ii1i Office of Driver Services m Iowa Department of Transporation Jan.24. 2017 2:04PM Div of Criminal Investigation No.2077 P. 3/8 01/23/2017 12t19Yellow Cab of Iowa City I (FA%)3193382708 P.002/002 STATE OF IOWACriminal .ttlllA j�`I't� HistoryRecord Request FormI To: Iowa Division of Criminal Investigation Support Operatlons Bureau, I" Floor 215 L 7'" Streel Dos Maines, Iowa 50319 (515)725.6066 (51s)—m 6080—1 az - I am remmorine an inwn Criminal Rlatnry Reonrd Cheek nm DCI Account Number _9967-F. or app ucabio) From: Yellow Cab of Iowa Clty PCO. Box 428 Iowa City, lA. 52244 (519)338-9777 Phones Fax: (319)339-7302 Last Name mandato First Name (mandatory) Middle Name (raaommandad SGI�oaPU�� ( L-oulS� Data of Birth (Inaadwory) Gender (mandslory) Social Securi Number reeommenaea ao ( ©Male gFemale S6L4 8q,53-)q36L48 Waiver information: Without a signed waiver from the subject of tho regNost, a complete criminal history record may not be releasable, per Code of lows, Chapter 692.2• For comnleta criminal history•rocord Information, as allowed by law, always obtaln It waivers! nature from the subject of the request. WolVar )?d1eaSe; I hereby glue pe mlaslon for the above reeu sling amclel to conduct an Iowa criminal history record check whir the Dlvlilen of Ctlminol Inrestlgation (DQ. Any criminal history doe 0oneor" me t et molmal c by yc DCC1 be rNeased as allowed by law. may Waiver Signartere: �le/%r✓t l ro/�Ir' ' Iowa Criminal History Record C Pck Results (Dcl use only) As of j-zLj - t a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCI = tr✓ crl Iowa Criminal History lteomd attached, OCI ' V DC1 initials -L_ DC147 (08/25/10) n :... J Tf... I.. nn na ll In. 1A DAR At, 1AA0