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HomeMy WebLinkAbout17-056IDENTIFICATION NO. (Office Use Only) 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 East Washington Street Iowa City. Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (319)3S6-5040 (3 19) 3S6-5497 FAX First Middle Last 1. Name (REQUIRED) 11,',_Inn e l l u r rt 2 r- o n S 0 ,-1 2. Address (REQUIRED) Z100 S. Sc off C I v d 3�' yb 1To_g C4yf, '5-,4 5 ZZ qo 3. Contact Information (REQUIRED) Email:Y;ke.rDS'Aun. of/s C rlol.coSellPhone:r3/q)3&3-1605 (All written communication sent a email) 4a. Driver's License expiration date (REQUIRED) 03Z8Z o Z Z T b. Taxicab Business Name (REQUIRED) ca � 1 owe C, 5. Prior experience in transportation of passengers: 6 V e o r S +g K l v S- n c s} 6. Have you ever been arrested / charged With any misdemeanors and/or felonies in this State or elsewhere? D Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? N 0 Type of offense Where When What happened to the charge? (Circle one) 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? 0 Type of offense Where When N O C7 r 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please p" a the nam U DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND ST DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLIC 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 hereby certify that I have issued to me by the Iowa De artment of Transportaton a valid Driver's license number 775 YY 11191/ issued on 0? z8 -r., expiring on 01178 z,zz . I understand that if I falsely answer any questions in this application, that this applicati n may be denied. I agr a 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 Applican Date STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me bytM� r��. • v ) . 9-010, ^Soo, on this day of S. and for the ytate of Iowa 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 sJ — Signature of Police C ' r designee y iw/ Dat 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 re of City Clerk or designee Approved application DCI report State certified driving record Website update ,\vA Date CIe AXIDRWBADGE PPL92014am ded.DOC 07/2016 Office Use Only n'< an r' =aC� M C:) _ o D N 0 CIe AXIDRWBADGE PPL92014am ded.DOC 07/2016 C Iowa Department of Transportation once of Drill sefy� (Toll Flee) 800-&V-1 121 PO gal 921{0, Des MMM, IA 503069204 515-244.9124 FAX 515.2391837 History Information CLEAR DRIVING RECORD Name: Robinson, Michael Turner DL/ID: 775YY1494 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: IOWA 3.0. T Name: Robinson, Michael Turner DL/ID: 775YY1494 4/11/2017 Office of Driver Services C:) Certified Abstract of Driving Record Iowa Department of Transporation ]7� Inquiry Date: 4/11/2017 DL/ID #: 775YY1494 (IA) Customer #: 2394989 Name: Robinson, Michael Class: D ID Status: None N Turner O Address: 2100 S SCOTT BLVD Audit #: 7930063 DL Status: VAL LOT 46 Issue Date: 03/28/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 03/28/2022 CDL Cert Status: None 522403017 Endorsements: 3 CDL Med Status: None Mailing Address: 2100 S SCOTT BLVD Restrictions: Corrective Lenses Restriction None LOT 46 Supplement: Date of Birth: 3/28/1976 Mailing IOWA CITY, IA Sex: M City/State: 522403017 History Information CLEAR DRIVING RECORD Name: Robinson, Michael Turner DL/ID: 775YY1494 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: IOWA 3.0. T Name: Robinson, Michael Turner DL/ID: 775YY1494 4/11/2017 Office of Driver Services C:) Iowa Department of Transporation ]7� -<F a rn 3� v I> N O 04Apr.}4. 20114_3 24PMoobDiv of Criminal Investigation (FAX)3193362"No.7394 P., 1/71002 STATE , IOWA 5"Jlt)Criminal History Record Check aGG}IIlli Request Form s, DCI Account Numbort 9967-F or.ppllseble) To: Iowa Dlvltlon of Criminal Investigation From: Yellow Cab of Iowa Clry Support Operations Bureau, I" Floor P,O. Box 428 215 C. 7" Street Des Moines, Iowa 50319 Iowa City, L,. 52244 (515) 725-6066 i5,sif a (319) 338-9777 Phone: FaXI (319)339-7302 I am raouestin¢ an Iowa Criminal Hictory Ranerd Chank nm Last Name mendsto ) First Name mandato Middle Name (reeormneoded) (DCI use only) k — /Z abin ori a2 , Date of Birth (mandatory) Gender (mandato) •Soglal•Securrif Number «eommendO ©. zVX 1')-7 Male ❑Female ��$" !b ' e1 9 7, Z-- WalverInformation: Without a signed.walver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2 For eomolate criminal histuryrocoeo Information, as allowed by law, a)ways obtain u walver signature from the sub eci of tho request. WaIVEr Ae/eaSd; 1 htfaby give pormisolon rbr the abevo ttquafling official to conduct an Iowa criminal hiftory record check with the Division of Criminal Invcstigetton (DCD. Any c(Iminsl history den concerning me that Is meinnlned by the DCI may be released as allowed by law. Waiver,SlgnaJure2� �l�E11/_ 7 JUW 1-x1 1 7 11 1112 1 kCklb IUI" LCCUVXU V UV GJ ll7 L5 (DCI use only) As of t.� a search of the provided name and date of birth revealed; o -, No Iowa Criminal History Record found with ACI )> .4 a cz�< -- ❑ Iowa Criminal History Record attached, DCI # Ct- yr : M o DCI initials N -- DCI -17 (08/25/10) Received Time Apr 3 2017 9:52AM i,1o.6452