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Home My WebLink About12-064Authorization Number /2 — G J+ 1 1 (Office Use Only) -�..a._ CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 41 0 East Washington street between 8 a.m. to 3 p.m., Monday — Friday.) Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX , First Middle Last 1. Name : '-t , "n ye, I t 14 I% ICI 2. Mailing Address 10 I 5- '- "-L- Ja 3. Telephone: Home I ` ' Z 8�1 `t Other: 4. Prior experience in transportation of passengers: v G1 r3 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? e 1 Type of offense 7upy- / 7- 'T v 7 Where When Clint i ( ✓"siIC(+I' f –5— 13 COLI N 2001 6. Have you'bebN convicted of operating a motor vehicle while under the influence of alcohol or drugsin the la'st five years?L4/ Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? el When Type of offense Where When s pe¢!c,('ny I'l �' C,T, 2'� 12 c "1 2o 1t 8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? N' Type of offense Where When 9. Have you ever applied to be an Iowa City taxis driver using a different name? If yes, please provide the name(s) V V J 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) dedtt dnvbadg 09/2010 I herebcertify that 1 have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number �qo Ji S81/ ro . 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 Date 2-12811,z f #R4Rff.lRRM4H4NHHHffffllfHfHff f fNHYHff H4HNHNllNH4HNfif ff #NN4RH#}#NF#'k#Yf YYNHHHNNfMf1f fIfNRRf;llNRR#N#i#4##F### STATE OF IOWA ) COUNTY OF JOHNSON ) S scribed and sworn to before me by Jysoh ��e _ ��S On this �� day of in and for the State df -low RRMRRRRR#Rt RRRRRR#RRNR*##tRR#iR*R*Rt#****R*R*#H#RRttR#NRRNRRRRRRRhI;;;;;4{;;h{34{3{{{##{#*Y*R#RRRRRRRRRRRRRR3;hR;;{#!;3#!;#3{i{{{{{#{{{i{;3 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). Signat re of Police Chief or designee Sign6ture of City Clerk or designee 2/2y Date _�7 9- /-Z 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 deddmd adgeaW2010,de 09/2010 Iowa Department of Transportation Office of driver Services (Toll Free) OM -532-1121 PO Box 9294, Des Maines, 7A 59366-a2W 515-244-91.244 FAX. 515-239-1837 Inquiry Date: 2/28/2012 Name: Hicks, Jason Yale Address: 1017 N SUMMIT ST City/State: IOWA CITY, IA 522455938 Mailing Address: 1017 N SUMMIT ST Mailing City/State: IOWA CITY, IA 522455938 Convictions Certified Abstract of Driving Record DL/ID #: 290jj5816 (IA) Customer #: 3968765 Class: D ID Status: None Audit #: 5454242 DL Status: VAL Issue Date: 08/18/2011 CDL Status: None Expiration Date: 07/19/2016 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Restrictions: NONE Restriction None Date of Birth: 7/19/1973 Supplement: Sex: M History Information Citation Date Conviction Date ACD Explanation County JUR 11/20/2008 12/09/2008�M14 Fail to Obey Traffic Sign/Signal (52 _ IA 07/30/2009 .08/18/2009 iM14 Fail to Obey Traffic Sign /Signal_ 152 IA 10/24/2010 12/07/2010 04/27/2011 w.� ES92 w SpeedX52 m. v.-.. N50 Improper Turn .i IA03/26/2011 µe52 � -'IA ! ` 10/15/2011 '01/19/2012 iS92 ....�....._... ..____ =_ Speed 52 JA Name: Hicks, Jason Yale DL/ID: 290775816 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: '•;7'/�;'4� 2/28/2012 IOWA 0 7 ).0.T.:W a. P09NER S Office of Driver Services �y I .� Iowa Department of Transportation Name: Hicks, Jason Yale DL/ID: 290jj5816 , oz/:Feb. 20. 20121 10:08AM Div of Criminal Investigation DCI IowNo.4648 STATE OF IOWA Criminal History Record Check RequestForm orm To: ' Iowa Divialoa or[thwdd I■veaft4 lon Supportoperatloha Immo, In Floor 115 It 70 Street DaMotnm,Iowe Mfg (511) 725-000 Fax RCI Aom=t Number. —_ tlrmi�tla� Fremt {IV�arcesTaxti 6 54nAs Dr... OU&Le4j. A 57)-)4u_ rhapa: two33r- FAX:._ ,'319 S51r8i9 1mO J OY.YYIP Nuunw .uurv. � •- ••�•� alp First Name MJddle Name Jgro., .' Yulr; Date of Birth has,, a,, Mr! Number //.naw -7114 /I'S am/lie OFemale I �Iaf vl 83" a-2.— q `-I 2 Waiver l+l%rnwion. without a al®1ed weber nom the "&Jen otthe rVitit, a eotaplete cttmmal hhmry record may oat beyeleaaabl%perCode orlow%Chapter6/1.1.For�4cNmlualbBlaryraoordtate matlan,aallowedbylaw,always abbin waivers ataretramthea afther Deet. Waiver Rekaw:ihaftove roowon forme abo.eregamiaeomcdmm��a�ewr Mnmy maid dwkwWbN[ivhjondGlmImI rnvddpdanpM Any oileW btKaydw oaaaaah.aer dxtb MoubeaMme u�laaYee oredm by I&.. Waiver ftriarure: As of —off ei a seornh of the provided name and date of birth revealed; ❑ No Iowa Crilninal History'Record found with DCI , l� Iowa Criminal Hlstory Record attached, IJCI N� T ` DCI initials Received Time Feb. 14. 2012 2;11PM No. 9179 , Feb.20. 2012 10:09AM Div of Criminal Investigation 02 ARRESTED 20070907 AGENCY: IA0520200 IOWA CITY PD IOWA CRIMINAL HISTORY DCI 00705854 INTERFERENCE W/OFFICIAL ACTS BODILY INJURY MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 COURT DISPOSITION DATE PRINTED - COUNT NO- 01 IA STATUTE IA719.1(1)B 2012/02/20 DCI:00705854 COURT CASR ID: 06521 AGCROB0742 CHARGE CLASS: MISDEMEANOR CONVICTION NAME: HICKS,JASON YALE TRK#: lAO02AR01 SENTENCE DOB SEX RAC NGT WGT EYE HAIR SKN FOB 19730719 M W 510 150 HAZ SRO PA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y POSSESSION OF A CONTROLLED SUBSTANCE CCR RECORD *w+ COURT DISPOSITION D1 ARRESTED 20030026 AGENCY: IAO52015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(5) AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA716-6 CRIMINAL MISCHIEF 4TH ' TRK$: 100939301 COURT DISPOSITION AORNCY: IA052015J JOHNSON CO DIST COURT COUNT WO- 01 IA STATUTE IA716.6(2) CRIMINAL MISCHIEF STH DEGREE COURT CASE ID: 06521 SHCRO66291 CHARGE CLASS: MISDEMEANOR COWVICTION TRK#: 100939301 RESTITUTION SENTENCE DISP EFF DAT FINE $50 20031021 02 ARRESTED 20070907 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA719.1(1)8 INTERFERENCE W/OFFICIAL ACTS BODILY INJURY TRK#: lAO02AH01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA719.1(1)B INTERFERENCE W/OFFICIAL ACTS, BODILY INJURY COURT CASR ID: 06521 AGCROB0742 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: lAO02AR01 SENTENCE DTSP EFF DAT JAIL 5D 20071207 FINE $625 20071207 03 ARRESTED 20100419 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE TRK#: 1A0096TO1 COURT DISPOSITION AGENCY: IAO52015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE No. 4648 P. 6/7 Feb. -20. 2012 10:09AM Div of Criminal Investigation COURT CASE ID: 06521 SRCR090SS6 CHARGE CLASS: NON CONVICTION TRK#: 1A0096T01 SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION DISCHARGED FROM DEFERRED JUDGEMENT $315 CIVIL PENALTY lY SELF -SUPERVISED, REVIEW 03/15/11 DCX 0070SB59 PAGE 2 OF 2 DISP EFF DAT 20100915 20100915 20110513 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRXMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJ$CT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION IN No -4648 P. 7/7