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Home My WebLink About17-064CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 3S6-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. (OfWe se 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 Middle 3. Contact Information (REQUIRED) Email: Q✓ en e— e. G h✓n P v f{.�6ell Phone: (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) /p7 //3/ ;�, 6 b. Taxicab Business Name (REQUIRED) I /W 5. Prior experience in transportation of passengers: G. 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? N O Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When Sft(d 3ah4Sdn OSI,?3/IS Seal [1;% 1111 %ad ]iMs.ne1�/ol,y e -7064so', 9l " 514,06 <:nn Oc631iA What happened to the char e'? (Circle one) onvic d 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 N O J 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pr(Wk It f) =lc-') DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE drfl ' , IFI& DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEFREWIEW cn You must apply for an individual Department of Criminal Investigation Report (form available uporiiequest). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa D partment of Transportatpn a valid Driver's license number I I %/1 L /o %l � issued on o N ill/17 expiring on &7//3/ 11 . 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 of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of ApplicantDate!(? �9aim 1 % STATE OF IOWA ) COUNTY OF JOHNSON ) Subs ribed, and sworn to before me by Q(A__Q IL k I rA C3 _ on this 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 Iowa City (Title 5, Chapter 2, City Code). Expirat(on da of D ' er's license Signature of, Potieib 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. City Clerk or !*R##*!*!*#########fly##i###4!!f!!!1R*R1fl1f!lflRiff!##################f#!i#liftiifiififftixeitifittfiittxiegyix O xiixxx,rx+ �J Office Use Only { � c-)-< N r Approved application <r"v m m DCI report o� ix a ry Q State certified driving record Website update cn Gerk/TAxIDRI B DGEAPPL92014 .ndW Doc 07/2016 Apr.24. 2017 4:09PM Div of Criminal Investigation .. . w. � r OI •rk v.. �... ... .. ..ru..v_.. No.778& P, .. 1/1 04/111/200117 laa:O_ 9dl /002 STATE OF IOWA Criminal History Rear.rd Check Request Forin DCI Account Number: 40c,;z —/ _�-(if applicable) To: Iowa Division o(Criminal Investigation From: City of Iowa City Support Operations.Eureau, 1" Floor City Clark's Office 215 E. 7" Street 410 E. Washington St cot �l�tga1nt�ar6c l�.n•a an¢lm Iowa City, LA 52240 (5195)) 7725-600680 Fax } Phone: 319-356-5041 Fax: 319-356.5447 1 am renuestina an lows Criminal Histo+, Record Check on: Last Name (mandatory) Fi1'St Nelle (mandatory) Middle Name rwommaidur As of 0;41M_ , a search of the provided name and date of birth revealed: Date of Birth (mandato Gender (mandalo Social Security Number (reeommnmdsd / 5W 91 RMale ❑Female 1-187-06-yti95 Waiver Information: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of lows, Chapter 692.2. For c m le c criminal history record information, as allowed by law, always obtain a waiver sitinatmrst from the subject of the request. Wsive? Release: I herWy sive permission for ilio above reauusing official to conduct an loma criminal history record chcok with The Division arcrinainal Investigation MCD. Any criminal history dais eoneernina me that is maintained by die DCI may be released as .Unwed by law. &-4 WaIVCY .SlgllalflYe: t Iowa Criminal History Record Check Results (Enna only) As of 0;41M_ , a search of the provided name and date of birth revealed: A_.e r No lo++m Criminal History Retold foundwith DCI v ❑ Iowa Criminal history Record attached, DCI d� _ C -n DCI initials _, M - DCL -77 (08/25/10)�- Received Time Apr. 19. 2017 2:47PM No -7518 ARTS ClJ10WADOT SMARTER I SIMPLER I CUSTOMER DRIVENVVVVW'IOVVBdOt gOV Inquiry 4/14/2017 Date: Customer 5205749 Name: Chung, Eugene Page 1 of 2 Office of Driver services PO Box 9204 1 Des Melnes, LA 50306A204 Phone: 515-2449124 1800-532-11211 Fat: 515-239-1837 www.iowadat.gov Certified Abstract of Driving Record DL/ID #: 117AC1023(IA) CDL Permit Class: None Class: C Audit #: 8233844 Address: 2115 PEMBROKESHIRE Issue Date: 07/08/2014 CDL Permit DR Endorsements: '07/11/201_2__ CDL Permit None Expiration 07/13/2019 ID Status: None Date: VAL City/State: CORALVILLE, IA 52241 Endorsements: NONE Mailing 2115 PEMBROKESHIRE Restrictions: Corrective Lenses Address: OR Restriction None Mailing CORALVILLE, IA 52241 Supplement: 05/23/2015 City/State: ._.L_____t 1592 __ Speed _ _ 'Johnson Date of 7/13/1991 Birth: Sex: M History Information Convictions CDL Permit Issue None Date: CDL Permit None Expiration Date: Explanation CDL Permit None Endorsements: '07/11/201_2__ CDL Permit None Restrictions: IA ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: Speed CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation County JUR 06/03/2012 '07/11/201_2__ S92 {Speed :Linn IA 12/12/2012 01/05/2013 592 _ Speed ^_ , D. O. T. ? Lei 4/14/2017 IA 09/10/2014 :09/19/2014 592 Speed _'Johnson !Johnson IA 11/29/2014 112/12/2014 F04 ISeat Belt Violation ;,Linn 'IA 05/23/2015 'OS/26/2015 ._.L_____t 1592 __ Speed _ _ 'Johnson _.. IA Name: Chung, Eugene DL/ID: 117AC1023 Pursuant to Iowa Cade 4321.10, 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 1 have been authorized by the Director of the IoSR Department of Transportation to so certify.71 "T7 In witness whereof, I have caused my signature and the seal of the Department to be set upon this dei.'uw&nt,W Ankerlr`fbwa this date: �-< J Ci m -t7 1 r 1 oM dtl Ln D. O. T. ? Lei 4/14/2017 http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord.aspx 4/14/2017 ARTS Page 2 of 2 �,�taa•.J�f Office of Driver Services Iowa Department of Transportation Name: Chung, Eugene DL/ID: 117AC1023 http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 4/14/2017 N O ^f. — n ::J http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 4/14/2017