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HomeMy WebLinkAbout17-034IDENTIFICATION NO. 1 l 1 (Office Use Only) ,�►r111���� APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday— Friday) 410 Last Washington Street Iowa City. Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) , 2. Address (REQUIRED) 3. Contact Information (REQUIRED) email) 4a. Driver's License expiration date (REQUIRED) - b. Taxicab Business Name (REQUIRED) �Ag j 5. Prior l experience in transportation of passengers: 11404'OU�1J LD G�S� k 'AA LSI S Cx n IN W Oi C 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? A&S Type ofoffense Where When 7. Have you been arrested /charged with any 7 suspenoeoead Guttty Other in the last five years? l LC I e of ense Where When 'MO -6r JV't' 12ISIII 101 What happened to the c e. cle one) Convicted Dismissed Deferred Suspended Plead Guilty Other., 8. Has your driver's licens eur's license been suspended or revoked in the last five years? 113 V 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 I 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 issued on expiring on . 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 appli tion and I further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions #Tit 5Xhapter,2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date / I STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 4:5 L.Ia. �Ly ckLlQf- on this % day of Marr!^ Zo1-7 �- ffiiYklflHHHffi`11HHffHIfHfHfllHff if ffYflHHfHfffHHHfHyf 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 / (bt— Signature of Police 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. Lt �/a /17 nature of ' y C�o�ignee:-' Date Office Use Only Approved application DCI report State certified driving record Website update CIeM1✓r IDRNIMDGEA{WL92014am ded.DOC 07/2016 C4610WADOT 2wed0 o� SMARTER I SIMPLER I CUSTOMER DRIVEN www 10 9 Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-91241800-532-11211 Fax: 515-239-1837 www.iowadot-gov, Certified Abstract of Driving Record Inquiry Date: 2/22/2017 DL/ID #: 781ZZ7885(IA) CDL Permit Class: None Customer #: 1045217 Class: A CDL Permit Issue Date: None Name: Graper, Ashley Nicole Audit #: 8503828 CDL Permit Expiration None _.. _. 13/19/2015 05/06/2015 592 Speed Date: IA Address: 2018 WATERFRONT DR TRLR 44 Issue Date: 10/03/2014 CDL Permit None Endorsements: Expiration Date: 10/02/2018 CDL Permit Restrictions: None Clty/State: IOWA CITY, IA 522404424 Endorsements: NONE ID Status: None Mailing Address: 2018 WATERFRONT DR TRLR 44 Restrictions: NONE DL Status: VAL Restriction None CDL Status: VAL Mailing IOWA CITY, JA 522404424 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 10/2/1982 CDL Cert Status: Excepted Interstate Sex: F CDL Med Status: None CDL Downgrades rype Effective End ACD Issuing JUR Downgrade 01/03/2017 01/09/2017 IA History Information Convictions :nation Date Conviction Date ACD Explanation County JUR [2/05/2011 03/09/2012 .592 'Speed MO 10/23/201402/13/2015 592 Speed (10 mph & under in 35-55 mph zone) Johnson IA _.. _. 13/19/2015 05/06/2015 592 Speed Wright IA )2/07/2016 '04/06/2016 592 Speed Lee IA Name: Graper, Ashley Nicole DL/ID: 781ZZ7885 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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 I 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: �.•'OWA 2/22/2017 g` I '': CC�a h?e1'• hya� NIYE� Office of Driver Services ttspcw�'•"� Iowa Department of Transportation Name: Graper, Ashley Nicole DL/ID: 7BIZZ7885 _:, Fe6,21. 2017 11:46AM Div of Criminal Investigation No, 4156 P. 4 02/17/2017 06:52Vel low Cab of Iowa City (FA%)3193382708 P.003/003 STATE OF IOWA ff Criminal History Record Check Request FormaaU DCI Account Number; —9967-F Tot Iowa Dlvlston of Criminal Investigation ornoCueebte) Support Operotlons Bureau, I" Floor From, Yellow Cab afIolva Cl 21$ Z, 7" Street I'•O. Box 428 Dos Molnes, Iowa 50779 (SIS) 725.6066 Iowa City, IA, 52244 (5]-57-25.6080 319)-338=9777 — ?hone; Fax; (319)339-7302 lam re uestin en Iowa Criminal Histo Record Chock on: Lost Name(mandeto klretN [Me mandato Middle Name (resommendc0l (&4)108 Date of Birth�mendalory) Gender mandato y) Social•Securl Number (roeommaneod) 1 of Z-It� �—:. ❑Mnto © male 1483—Dz" / p Walver Information: Without a signed walvor from tho subject of tho request, a oomplgtc criminal history record may not be releoaablo, per Coda of lolva, Chapter 692.2. For complete criminal history.r000rd Information, as a)lo obtain u wnlversl velure from the suh got of the roauost. wod bylaw, always Waiver Releasat I hereby give RM1111408 ibr [Ito abo rcqucslIng omoid to eandw.n t Iowa Criminal history record check whh d1e DivisionorC.lminel Invcrtl8aion (DCO. My erlmlrel bbtory data conoa 6 the, mtlntelne by the DCI maybe released as allowed bylaw, Waiver Sigxnrure- Iowa C 'urinal istor cord Check Results (Del tae only) As of a i�, a search of the provided name and data of birth rcvoaled: ❑ No Iowa Criminal History Record found with DCT Iowa Criminal History Record attached, DCI 4 6 SC8k3 DCI initials A c— DCI -77 (08/25/ID) r.• 11—:,.J T:... 1.1. 11 1n 11 n. nn.0 a �n�n Feb.21. 2017 11:46AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00650813 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2017/02/21 DCI:00650813 NAME; GRAPER,ASHLEY NICOLE DOB SEX RAC HOT WGT EYE HAIR SKN POB 19821002 F W 505 170 GRN BRO PAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT BACK TAT L FOOT TAT L SHLD TAT R ANKL TAT UL ARM CCH RECORD •*+ 01 ARRESTED/TAXBN INTO CUSTODY 20010612 AGENCY: TA0920100 WASHINGTON PD CHARGE NO- 01 IA STATUTE IA124-401-5 POSSESSION/MARIJUANA TRK#i 055399601 COURT DISPOSITION AOENCY: IA092015J WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401-5 POSSESSION MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 055399601 SENTENCE DISP EFF DAT DEPERRED JUDGEMENT 20011009 COURT COSTS 20011009 PROBATION lY 20011009 JAIL 7D 20020117 FINE $250 20020117 COURT COSTS 20020117 RESTITUTION SERVICE 20020117 REVOKED 20020117 02 ARRESTED/TAKEN INTO CUSTODY 20020305 AGENCY: IA0920100 WASHINGTON PD CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTOXICATION TRK#: 055423901 COURT DISPOSITION AGENCY: IA092015J WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION COURT CASE ID: 08921 SMSM036477 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 055423901 SENTENCE DISP EFF DAT JAIL 5D 20020320 CREDIT W/TIME SERVED 20020320 No. 4156 P. 5 Feb:211. 2011 11:46AM Div of Criminal Investigation 03 ARRESTED/TAKEN INTO CUSTODY 20080620 AGENCY: IA0520100 CORALVILLE Pb CHARGE NO- 01 IA STATUTE IA726.6(7) ENDANGERMENT/NO INJURY TRK# : 1A004 FTO1 COURT DISPOSITION AGENCYt IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA726.6(7) CHILD ENDANGERMENT/NO INJURY COURT CASE IDi 06521 ACCROB3748 CHARGE CLASS: NON CONVICTION TRK#i lAO04FT02 SENTENCE DEFERRED JUDGEMENT PROBATION lY DISCHARGED FROM DEFERRED JUDGEMENT DCI 00650813 PAGE 2 OF 2 DISP EPP DAT 20051024 20081024 20090819 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 FIWGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DRNY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No. 4156 P. 6