The URL can be used to link to this page

Home My WebLink About17-048� r 1 • rw1®�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)356-5040 (3191356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. � 1-0141 (Office Use 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" information will result in denial of the application 3. Contact Information (REQUIRED) Email: liar r- ,G6 Cell Phone:,3/ 7-fW --254�G (All written communibdtion sent via email) 4a. Driver's License expiration date b. Taxicab Business Name (REQU 5. Prior experience in transportatio 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 one) Convicted Dismissed Deferred Suspended Plead G Other Have you been arrested / charged with any traffic offenses in the last five yea . Type of offense ^ Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended lead Guil 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 A 9. Have you ever applied to bean 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 certrfy that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 2ygA��I old( issued onob-12-JOY expiring on 0L-D(t-,)0Ir . 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 oj,Title 5,. Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applica '4�—— Date3-o:3 - I STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by p u e C,P . ? kk c. u 1, on this �l day of 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 g4Lq[ Iowa City (Title 5, Chapter 2, City Code). ofriver' license � / � 0 11 Z :e Chief or designee ate AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MOR THAN ONE YEAR FROM THE DATE LISTED BELOW. I� 3,Z Signature of City Clerk or designee D to Office Use Only Approved application DCI report State certified driving record Website update CIBrkJTAXIDRNBADGE L92014emended.DOC C1J10WA00T-..' r: wwwiowadot.gov SMARTER 1 SIMPLER I CUSTOMER DRIVEN Inquiry Date: Customer Name: 3/21/2017 1845805 .Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-2449124 1800-532-1121 I Fax: 515x239-1837 www_iuwadot.gov Certified Abstract of Driving Record DL/ID #: 249AD7128 (IA) CDL Permit Class: None Class: D Behrmann, James Patrick Audit #: 7873890 Address: 320 2ND ST RM 218 Issue Date: 03/12/2014 City/State: CORALVILLE, IA 522412677 Mailing 320 2ND ST RM 218 Address: Mailing CORALVILLE, IA City/State: 522412677 Date of 8/6/1981 Birth: Sex: M Expiration 08/06/2018 Date: Endorsements: 3 Restrictions: Corrective Lenses Restriction None Supplement: History Information CLEAR DRIVING RECORD Name: Behrmann, James Patrick DL/ID: 249AD7128 CDL Permit Issue None Date: CDL Permit None Expiration Date: None CDL Permit None Endorsements: Office of Driver Services CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: Office of Driver Services CDL Cert Status: None CDL Med Status: None 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: ........ ?'/vy 3/21/2017 IOWA :.* r c� r..... 4`=E Office of Driver Services �a 11111% Iowa Department of Transportation Name: Behrmann, James Patrick DL/ID: 249AD7128 Mar, 22. 2011 3: 11 PM Div of Criminal Investigation No. 6308 P. 1/1 F �i.– – — C'a'.- v...,.., ---------. 03/21/2017 10:Ur 487W V.U021002 STATE OF IOWA Criminal History Record Check RequestForm t� DO Account Number: K OD 1, --2= — prappbcsble) To: Iowa Division of Criminal Investigation From: City of lows City Support Operations Bureau, V Floor City Clerk's Office 215 E. 7111 Street 410 C, Wankinvinn Street Des Moines, Iowa 50319 _ (515) 725-6066 lows City, [A 52240 (515)725-6080 Fax Phone: 319-356-5041 Fax: 319-356-5497 I asn retsaestina an Iowa Criminal I-Iistnsv Rennrd Cheek nn• Last Name (mandatary) First Name (mandatory) Hiddle Name (recommended) 1 Date of Birth (mandatory) Gender (mandatory) Social Security Number (recommended) Omsk OFemale 5 Waiver• Xnjormalion: R9(hou( a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For coma lets criminal history record information, as allowed by law, always obtain a waiver signature Dom the sub ect of the request. Waiver Release: I hereby give permission far the abovemquestimg official to wnduct N Iowa criminal histop•'cold check uilh she Divislon ofCriminai lnvesligatim(DO), My Criminal hislory data waecmina me that is maintained by the DCI mq• be released es allaxed by lasv. Waiver Signattir e% ;�G�blld- — Iowa Criminal History Record Check Results (9ci use only) As of 112 1 ! a search of the provided carne and date of birth revealed: r bf-�o lova Criminal History Record found with DCT ❑ Jowa Criminal Hislory Record attached, DCl DO initiaZz"', 1)C1-77 (08/25/10) Received Time Mar. 21. 2017 9:41AM No, 5146