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Home My WebLink About17-153T � r CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. (Office Use Only) APPLICATION FOR TAXICAB / 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: (?S rM dtnyl$oH G mail) ell Phone: written communication sent via email) 4a. Driver's License expiration date (REQUIRED) - i 3 b. Taxicab Business Name (REQUIRED) 421 lOU CAb 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?Ye!; Tvoe of offense Where When What happened to the charge? (Circle one) '+/It Convicted Dismissed D�Suspended Plead Guilty Other Have you been arrested/ charged with any traffic offenses in the last five years? t' V Q 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 ,VO 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) No 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 certify that I have issued to me by the Iowa Department of Transpo tion a v id Driver's license number735--�.7 Y 73issued on 3 /1 expiring on r u �- 0_4 1 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 Applicant` � Date r ✓' STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Tf�,S; �, tk,-y1�titi5o on this f� 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 City of Iowa City (Title 5, Chapter 2, City Code). Expira on dat f; Dr' er's license '/z 1 Sign ure f Police Chief or designee I 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. Sig ature of City Clerk I designee Office Use Only Approved application DCI report State certified driving record Website update // /-7 17 Date aeWTA%IDRNaADCEAPPL92014amende .DOC 07/2016 Nov.14. 2017 9:46AM Div of Criminal Investigation No.6111 P. 7/8 IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI,OO641421 NAME: E,JE99IE E JOHN90N,JESSE MICHAEL JOHHSON,JESSIB E JOHNSON,JRSSIE MICHAEL DCI 00641421 PAGE 1 OF 2 DATE PRINTED - 2017/11/14 DOB SEX RAC HGT WGT EYE HAIR GKN POB 19860618 M W 511 215 BRO BRO FAR IA 19880619 ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20060903 AGENCY: IA0520000 JOHNSON Co so CHARGE NO- 01 IA STATUTE IA321J.2(2A) OWI 15T OFFENSE TRK#: 101961001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEH WH INT (OWI) / IST OFF COURT CASE ID: 06521 OWCRO77050 CHARGE CLASS: NON CONVICTION TRK#: 101961001 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTIENCE DISP EFF DAT APPEAL DATE DEFERRED JUDGEMENT 20061213 PROBATION lY 20061213 20070613 SELF -SUPERVISED DISCHARGED FROM 20070625 DEFERRED JUDGEMENT 02 ARRESTED/TAKEN INTO CUSTODY 20131004 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA155A.21 UNLAWFUL POSSESSION OF PRESCRIPTION DRUG TRK#! 1AO0HONO1 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA155A.21 UNLAWFUL POSSESSION OF PRESCRIPTION DRUO COURT CASE IDz 06521 SRCR103130 CHARGE CLASS% MISDEMEANOR CONVICTION TRK#: IAOOHON01 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20140128 PROBATION lY 20140128 JAIL 4D 20150514 Nov.14. 2017 9:46AM Div of Criminal Investigation No.6111 P. 8/8 FINE COMMUNITY SERVICE $315 MAY PERFORM IN LIEU OF PAYMENT OF A MTS DUE DCI 00641421 PAGE 2 OF 2 20150514 20150514 REVOKED 20150514 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 RNPORCEMRNT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION Iowa Department of Transportation pllSca of Dm of Saw(= (Tall Free) 800-632-1121 Pt? 13ox !3204, Doss Mcinas, Ui 50JIM-72N 515-24x-5424 FIS 516-239-1937 Certified Abstract of Driving Record Inquiry Date: 11/13/2017 DL/ID #: 556YY1735(IA) Customer #: 1084776 Name: Johnson, Jessie Class: C ID Status: None 01/31/2016 Michael F04 Seat Belt Violation IN Address: 1012 N SUMMIT ST Audit #: 1910065 DL Status: VAL APT A Issue Date: 06/23/2017 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 06/19/2023 CDL Cert Status: None 522455939 Endorsements: NONE CDL Med Status: None Mailing Address: 1012 N SUMMIT ST Restrictions: NONE Restriction None APT A Supplement: Date of Birth: 06/19/1988 Mailing IOWA CITY, IA Sex: M City/State: 522455939 History Information Convictions Citation Date Conviction Date ACD Explanation Count ]UR 09/03/2006 12/13/2006 A20 Deferred Judgment OWI Johnson IA 01/31/2016 04/12/2016 F04 Seat Belt Violation IN Operating While Intoxicated Test Refusal/Test Failure Violations Occurance ACD Ex lanation JUR Count 109/0312006 A98 I OWI Test Failure IA 103/12/2007 Sanctions Type Effective End ACD Explanation Occurrence ]UR JUR Revoked 109/14/2006 103/12/2007 A98 I OWI Test Failure IA IA Name: Johnson, Jessie Michael DL/ID: 556YY1735 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.