Loading...
HomeMy WebLinkAbout12-024`1—IV = -4 CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX Authorization Number 11-_ _n � (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 1. Name First cj�m4j Mjddl� T/YB))1G.Y�_ 2. Mailing Address X15 Oom I/Y �eo.4 S) �det3ot Ct""f �a 5 X22 5� 3. Telephone: Home 3 3--), Other: 4. Prior experience in transportation of passengers: /-� �R f 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Al Where When U 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When N© 7. Have you been convicted of any traffic offenses in the last five years? AUC! Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /UG 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) /VG 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) d.rMt idrivbadg 09/2010 I hereby `cgrtify that yve issued to me by the Iowa Department of Transportation a valid Chauffeurs license number T I understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will 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 a license 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 !r ceIg Date x/ /2- STATE OF IOWA ) COUNTY OF JOHNSON ) ub\s\cribed and sworn to before me by J w,, e �� o� a �� no{� C dL On this day of �btv qv'eZ0\ 4M ' 713(q in and f r the Sthte of Iowa I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). or designee .ii Date a- 7-1.2� Date After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update derkXaddrMmdgeapp2010.dm 09/2010 0 Feb. 7. 2012 1:37PM Div of Criminal Investigation No. 2885 P. 5/9 �u•JI. LVIL U.•rvnw ol,r dein - UIty el loved blly No. zV91 I. L To: Iowa Yilwlslorn otcrlminalynvestlgalroh support oporaffons 13rtroalr,1"Nloor 216E.7'hSfreoE ball Kolneq,IOAVA 50319 (s1s)'ia5-6o66 (515) 725-6oea Nax I,I 1 I I'I \ �� �) ^ s°d STATE Recovil Check hnl�C ai,Y e Repeat Yorm Ul • DCXA000untNum6or: �•-•� peePylloee o) Fromr _XM pH IftVA GXTr CITZ CLEW" s orrxa 410 B. WAsaaLcj a gwET ZowA CITY 7rRYA._ K?7{�u . krnXl q19-35C>=5Lo97 L am rea owt(ie nninVra Criminal RY6ctnro T7A,ord (1162 Jlaio oI'lBla�t4 end► 11- y 3� l�triverxf{%orftlgttan ho roleasnhIc� per Cade _obxaYrt A walverslanato XYratveP_k21e[ise, YGereD rnvosl(polfonrpcq. Myorlmh JA t,ne3 r)o h'V- ILF N410 b)F'einale I -7:1,3:-, 8':29'47 Wfffiout a sfndd Wn(vertt om thesu6jaot ortho request a comploto cFlminal nlstory rcoord may not rxowA, Chapter 692,2, Ibr cotnalefa•arimfnalhistory record infotmgtlolr, adallawed by IAV/j AlWays to wndu0l grl town orlminal hl,loryteeord ehaakWhh IhoDViafon oeC,rmrnol r>heb0lmeybarofcavad'asnlrovvc46ylnTv. duwtt UratnaLIHI WsrorV AeCOAUUIOCK,l (OURS , MCI OSOonly). As of a search of thoproAded name and date ofblak-revealed: NoIoWaG4uninal7�isforyRecord!Pobnd}41ChX)CX • Yo'Wa O1� nal RIstozy Reoord attached, b CX # 1XX ACI -77 (08/25/10) T 'Received Time Jan, 31: 2012 8:40AM No, 7605 i CC& Iowa Department of Transportation Office of Driver Services (Toil. Free) SM -532-1121 PO Box 9204, Des Moines; IA 50306-9204 515-244-9124 FAX. -'515-239-1837 Inquiry Date: 2/7/2012 Name: Knoplck, James John Address: 815 E Bloomington St City/State: Iowa City, IA 52245 Mailing Address: 815 E Bloomington St Mailing City/State: Iowa City, IA 52245 Convictions Certified Abstract of Driving Record DL/ID #: 721YY8794 (IA) Class: A Audit #: 2619111 Issue Date: 10/07/2008 Expiration Date: 11/04/2013 Endorsements: N Restrictions: NONE Date of Birth: 11/4/1939 Sex: M History Information Customer #: 1678355 ID Status: None DL Status: VAL CDL Status: VAL CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County 3UR 02/13/2009 X03/13/2009 Miscellaneous ,57 11A ! Name: Knoplck, James John DL/ID: 721YY8794 Pursuant to Iowa Code §321.10, I, Kim Snook, 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: '•;T/°4 2/7/2012 IOWA0. `�2°.' ....... $ 10 Office of Driver Services Iowa Department of Transportation Name: Knoplck, James John DL/ID: 721YY8794