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Home My WebLink About12-1125. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ki Tvpe of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? tI � Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? \j` Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) 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) derkJt xidrivt,adg 09/2010 I ) I Authorization Number_ • l 1 (Office Use Only) 7t� memo 1 tea. •tom_ 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 2240-1826 9) 356-S0 (4 (319) 356-5497 FAX f First 1. Name M' ��jjlddlee, Last hlexart�( �1dC� 2. Mailing Address g� f 5�{�fI`.�( /�Q �0 3. Telephone: Home �3 HZ1 ?VL'� Other: 4. Prior experience in transportation of passengers: SA -n\ WS Vt;a rC 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ki Tvpe of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? tI � Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? \j` Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) 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) derkJt xidrivt,adg 09/2010 I herebycerl that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 5 4 3 A �l `6 7 �) . 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 an "documents relating to this application, and I further agree that, if a license is granted, to comply at all times with all of the p visions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) / Signature of Applicant i -V GW /�Z Date t i I) f l.�' Ni1R}RRRYR4R}f!R}flfRRfyffRtk{'ffRf}}Rff1R4f}}1}i11}itflflfffll,}f1RffM4f1fI1,ff�}RfflfflRlf}fRfilf}1f1}}1fflitlRRlfltlflfflRRRRRifflf R}fff RffiRlf STATE OF IOWA ) COUNTY OF JOHNSON ) f Subscribed and sworn to before me by V e ��r'� ^ )L On this day of $��xELUionE N' Commissumber221B19 Notary Public in and for the State 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). Signature of Police Mief or designee U/ X-/. T Cli1i1/ Sign ure o ity Clerk or designee "4 /'r.''is Date !9! ;L/- /�-X- 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 Sao- is vbaeeeapp=0.a 09/2010 x Jun. 11. 2012 10:52AM Div of Criminal Investigation No. 8496 P 1/4 V V . 1. u 4V 1 L L• J U. V i V I, r .,Ola V I l r V I 1 V V a V I L h U. L i i.) 1. 11 -;;..STATE OF IOWA Criminal 14istoryRecord Check '1HIM 1v)Requestt To: Iorva Division of Criminal Illvcstlgatlon Support 0peratlons Bureau, V b'loor 215 E. 7'a Street Aes Moines, Iowa 60319 (515) 929.6066 (515) 725-6080 Fax I am reauestine an Iowa Criminal Matory Rocnrd Check nnc DCIAccountVumher•: �Qa — I� (if appllcnblo) From; CITY OF IOWA CITY CITY CLERIC'S OFI M 410 E. WASHINGTON STREET IOWA CITY IOWA 52240 Phone: 319-356-5041 Fax; 319-356-5497 i.ast N2MO (mandato Mrgt Name (mandaloo iMiddleNftlne recommendoa 1�- FRANK S�R�M� AI—�cquu>r� bate of Birth (mandatory) Candor (meadalory) Social Security Number rccommcnded 031 a g l U IQIllili ale ❑I±oraalo 51'1-0 V Md-) Waivel.Inforniradali Without a slgned walver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692,2. For comnlefe crlminal history record Information, as allowed by low, always obtain a wnrver sl nature a-om the subject of the request, Wal'verRelel%Xe:Iheatygivepcmuadonforlhcebovorequdi eslingofllolelloeoa adIowa criminal lelslory record checklrilhIli: Division ofCriminal lgYwllgetlon(M).Any criminal history dmownamirgm�dlain(81111146 Clhlnyboreeffcaasoddasallowed 6ylaw. wa'iver s gllafllre; _ Iowa Criminal History Record Check Results (Dervso only) As of % f 'oL a search of the provided namo and date of birth relrealed; = No Iowa Criminal History Record found with DCI ' ❑ Iowa CrJminal History Record attached, DCT # I.) Del Received Time'Jun. 1.' 9012 2:58PM No.128 iL4Iowa Department of Transportation Y-Ic"A� Office of Driver Services (Toll Free) BOU-5324121 PO Box 9204, Des Moines, IA 5030ir92O4 515-244-18 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 5/30/2012 DL/ID #: 580AH8756 (IA) Customer #: 5920125 Name: Frank, Jeremy Alexander Class: B ID Status: None Address: 831 E JEFFERSON ST APT 8 Audit #: 5841062 DL Status: VAL Issue Date: 03/07/2012 CDL Status: VAL City/State: IOWA CITY, IA 522452439 Expiration Date: 03/08/2017 CDL Cert Status: Excepted Intrastate Endorsements: PS CDL Med Status: None Mailing Address: 831 E JEFFERSON ST APT 8 Restrictions: Corrective Lenses Restriction None Date of Birth: 3/8/1987 Supplement: Mailing City/State: IOWA CITY, IA 522452439 Sex: M CDL Medical Examiner's Certificate Certificate Specifics Explanations History Information CLEAR DRIVING RECORD Name: Frank, Jeremy Alexander DL/ID: SBOAH8756 Pursuant to Iowa Code §321.10, 1, 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: `.�'••••'•'�/ 'V 5/30/2012 W D. 0. T. f QR�$= Office of Driver Services Iowa Department of Transportation Name: Frank, Jeremy Alexander DL/ID: 580AH8756