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Home My WebLink About12-048�r � 7krIII ,44 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name ;- 2. Mailing Address 3. Telephone: Home 4. Prior experience in transportation of passengers: Authorization Number AZ — Z& (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) r Other: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Whereen 6. Havtygd'tSe Dcted f e' aAn a motor vehicle whileu� the 1 u ne ce bt akohol or dru sin a last five years? U Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 41 'e Type of offense Where When 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? A/(� Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? I 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) 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) clerWlaxidnvbadg 09/2010 C. I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 9r'� S_ A d Y01 ) . I understand that if I falsely answer any questions in this application, that this applic t -may be denied. Punderstand 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 ]/k41Y1 1/ IyI Date %�� Z) 1 .2 o ######YY#Y#Y####Y###Y##4Y#4Y#Yf#1ffY'Rff#'ff#Y#M#111f!!f1#4fYffY#YYY###'#f#4#YYfffllff#1fff4li!!Yf###Y###'#!#ifffiflf4f#Yfffififfl#f,!#YH#4Y######f# STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by 54evfn (.fia✓nt� SLV,acc On this 3a day of C) r irr SONDRAE FORT $t�-b comm^ssfon Numo ,r 1 se7st Notary Public in and for the State of Iowa h111f11R11f#11#114#Rt1RRf*##f1Rf14fff4f4f#f1f4R141###1*#*i*#f#*#11Rf#11111111141#4###4414####1##M#R111Mf11R1fff1111!141#4###41tt#*#t#1f#fiR**#f 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). Sign fe of li Chief or designee ign ture of City Clerk or desigriee Date /a 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. 1f!!!'R!/1M/!f!#!#1Hfi:14f#f1!!##I#fR##1/#fit##MfM###Y#iY#'F###!#fllfi11111111111!!f#/######H#####!!1M#f!lflffilflfl!#Y1flR 11fe#RR/4/#######4+RH Office Use Only Approved application DCI report State certified driving record Website update �vbedp W2010e 09/2010 CA Iowa Department of Transportation Office of Driver Services (Toll Free) WO -532-1121 FO Box 9204, Des Mo nes, IA 5030"204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/22/2012 DL/ID #: 435AA5012 (IA) Customer #: 224854 Name: Shrock, Steven Warner Class: D ID Status: None Address: 4487 490TH ST SE Audit #: 3482574 DL Status: VAL Issue Date: 07/08/2009 CDL Status: None City/State: IOWA CITY, IA 522408288 Expiration Date: 01/17/2013 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 4487 490TH ST SE Restrictions: NONE Restriction None Date of Birth: 1/17/1946 Supplement: Mailing City/State: IOWA CITY, IA 522408288 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County 3UR 12/08/2006 103/20/2007 jM70 Improper Passing 52 iIA - Sanctions Type Effective End ACD Explanation Occurrence IUR 3UR -------'------ - -. _ ...--_..__r_... Suspentled 11/11/2004 ;04/10/2005 Fall to Post Security for an Accident -Owner Only IA Name: Shrock, Steven Warner DL/ID: 43SAA5012 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: Name: Shrock, Steven Warner DL/ID: 43SAA5012 2/22/2012 • i Office of Driver Services Iowa Department of Transportation b1feb.20. 2012 9, 59AM Div of Criminal Investigation No. 4646 P. 3/5 „.. ab o. �v,.�..�,r 319-338-2706 P. i STATE OF IOWA Criminal History Record Check Request Form To: Iowa Division of Crtlninal lavtstigatinn Support Dperallons Bureau, P` Floor 215 E.?" Street Des Molnes, Iowa 50319 (515) 725.6066 (515) 725-6080 Fax 1 am requesting an Iowa Criminal History Record Check on- DCI Account Number: _9967-F tifopplieable) From; yellotyCab oflowaCity P.O. Bos 428 Iowa City, IA. 52244 (319)338-9777 Phone: Fax; (319) 339-7302 Last Name ) First Name (mendetory) Middle Some oxt*mmcnded) /(monde S% 4m( ( 599ock S�M/ 5;i6vErul Date of Hirthtmmdwo[y) Gender(mandam) Sloe�ia]•Se(curi Number (recommended) l r % Male ❑Female - ! PX 09 z Jr Waiver Inforinaliotr: Without n signed walver from the subject of the request, a complete erllmlnol history record may not be rden noble, per Code of Iowa. Chapter 6912. For complete criminal history record information, as allowed by law, always obtain a waiver signature from the subject or the request. Waiver Release: f hcrcby give pemtission for the above requesting official to wnducl an Iowa cilminal history record check ivil6 the Division of cfiminel Investigation (Mn. Any criminal history dau wnceanlag m dhoti Inedby lheDCl may be otcd allowed by lay. Waiver Signature: Iowa Criminal history Record Check Results MCI use only) As of oL.20 — a search of the provided name and date of birth revealed: i I ❑ No Io•u'a Criminal History Record found with DCI Iowa Criminal History Record attached, DCI if i I DCT initial DCI -77 (08125/10) Received Time Feb. 14, 2012 2:14PM No, 9177 Feb.20. 2012 IO:OOAM Div of Criminal Investigation No.4646 P. 4/5 IOWA CRIMINAL HISTORY DCI 00186530 FELONY CONVICTION PAGE 1 OF 2 DATE PRINTED - 2012/D2/20 DCi;00186530 NAME: SHROCK.STEVE SHROCK.STEVEN WARNER DOB SEX RAC HGT WGT kYE RAIR SKN POB 19460117 M W 508 180 GRN BRO MED IA ADDITIONAL IDENTIFIERS SC L CNK CCH RECORD *** 01 ARRESTED 19721194 AGENCY; IA0770000 POLK CO 30 CHARGE NO- 01 DANGBROUS DRUGS/POSSEBSION OF CONTROLLED SUBSTANCE TRK#i: L07373601 COURT DISPOSITION AGENCY: IA077015J POLK CO DIST COURT COUNT NO- OS DANGEROUS DRUGS/ POSSES91ON/CONTROLLSD SUBSTANCE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#{: L07373601 SENTENCE PLEAD GUILTY JAIL IBOD 02 ARRESTED 1974043D AGENCY: IA0070300 WATERLOO PD CHARGE NO- 01 IA STATUTE IA204-401 DANGEROUS DRUGS/POSSESSION/CONTROLLED SUD/INTENT TO DELIVER TRW L01373701 COURT DISPOSITION AGENCY; IA007015J BLACK HAWK CO DIST COURT COUNT NO- 01 POSSESSION/CONTROLLED SUBSTANCE WITH INTENT TO DELIVER CHARGE CLASS: FELONY CONVICTION TRKI: L07373701 SENTENCE - DISP EFF DAT PROBATION 19751025 SUSPENDED 5Y 19751025 03 ARRESTED 19900722 AGENCY: IA0520000 JOHNSON CO 50 CHARGE NO- 01 IA STATUTE IA236-12-2 ASSAULT/CAUSING INJURY/ DOMESTIC ABUSE TRKft: L07373801 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT ND- 01 IA STATUTE IA236-12-2 ASSAULT CAUSING INJURY Feb.20. 2012 IO:OOAM Div of Criminal Investigation DSl: 00106530 PAGE 2 OF 2 CHARGE CLASS: MISDEMEANOR CONVICTION TRK$: L07373001 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT PROBATION lY 19901212 SUSPENDED 30D 19901212 3ATTERER'9 EDU FROG 19901212 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 ENFORCEMENT AGENCIES BY THE DDCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION BURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No.4646 P, 5/5