The URL can be used to link to this page

Home My WebLink About12-135Authorization Number / 0- — / 3 5- % 1 (Office Use Only) ,�(r"III yL 4 A®1�� APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (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 1. Name � First S 6 Middle Veit h U i Last N I h4 2. Mailing Address D-� 0 I ( G LNC i V 1 3. Telephone: Home 1 I - t1 g � Other: �jv fL2 4. Prior experience in transportation of passengers: ti J'// q I k / t- a , a -tato1 t 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /" d Type 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? Af 0 Tvpe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where �t L� When 8. Has your driver's license or chauffeur's 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 taxi driver using a different name? If yes, please provide the name(s) N� 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) deA/ idn badg 06/2012 I hereby certify that yI have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number H y � �-I 63(91 . 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 )vith all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) / Com-1TJ� IZ Signature of Applicant Date-7� STATE OF IOWA ) COUNTY OF JOHNSON ) Sub cribed and sworn to before me by Se�'� ' �� O� On this day of I 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). Sign t re of P i XChief or designee k) Sign tore of City Clerk or designe '7 -27 -IR Date Date NOT VALID UNTIL Police Chief and City Clerk have approved and authorized taxi driver names placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. H###+#####*#**#***R****#*R*R**f*##f#*#######+####*#+####f##R**R#R#**####*#*#RRR*}f*}#*##RRMRRRYRR***RR*RR*R*YYY*NYY**#R#f#4###4###*f#RfM*}RMY* Office Use Only Approved application DCI report State certified driving record Website update d.rM.idnvbdgeapp2010.d« 06/2012 Jun.26. 2012 10:03AM Div of Criminal Investigation No.0635 P. 1 Jun to is vo.��n ienu,v Cab u, iuw4 ny 319-338-2708 p.[ STATE OF IOWACriminalffistory Record Check yl,n nY1✓e�tti: R:quest Form iii To: rowR DiVISlnn of Criminal Investigation Support Operations Su rcau, I' Floor 2158. 7° Street Des Moines, Iowa 50319 (SIS) 725-6066 (515)725-6080 Fax I am reouesihip an Iowa Criminal HistoryRecord Check on: DCI Account Number: 9967-F ,- (if •pplicablc) From: Yellow Cab oflown City P.O. Box 428 City, IA. 52244 (319) 338-9771 Phone; Fax: (319)339-7302 Last Name (manaazay) First Name (maadaiory) Middle Name (recammendW) N EAU M A- jJF(e�A N c,.is Date of Birth 6eandstay) Oc ider (mandatory) Social-Security/Number (rcco=cndad) ®Male ❑Female Waiver Informatkn: Without a signed waiver from the subject of the request; a complete criminal history record may not ! be releasable, per Code of Iowa, Chapter 6922, For complete criminal history record Information, as allowed by iow, always obtain a waiver si natare from tho subject of the re west. W01110P RejeaSle. I hcaby give pesmissien for sac aboyc rcgpentng official to condoel an Iowa criminal history record toed gitb the Division of Criminef ravcrligetion(DCI). Any criminal historyden concerning mcthaii ainlained by she DCl maybe released as ellowr4 by low. fflaiver Signature: Iow'/ a Criminal History Record' Check Results As of i -a6 -0. , a search of the provided name and date of birth revealed: 0 No Iowa Criminal History Record found with DCI ❑ Iowa Csiminat Higlory Record attached, DCI DCT initials DCI -77 (06/2S/10) Rect1verl Time Jun. 18, 2012 9:35AM No. 8198 (Dcr uspoaly) Iowa Department of Transportation ►�r t Office of Driver Services (Toll Free) BW -532-1121 PO Box 9204, Des Manes, IA 50305-92114 515-244-912:4 FAX: 515-239-1837 Inquiry Date: 6/1/2012 Name: Nealon, Sean Francis Address: 2401 HIGHWAY 6 E APT 3416 City/State: IOWA CITY, IA 522406788 Mailing Address: 2401 HIGHWAY 6 E APT 3416 Mailing City/State: IOWA CITY, IA 522406788 Convictions Certified Abstract of Driving Record DL/ID #: 433YY0367(IA) Class: D Audit #: 3577623 Issue Date: 08/06/2009 Expiration Date: 10/30/2012 Endorsements: 3 Restrictions: Corrective Lenses Date of Birth: 10/30/1969 Sex: M History Information Customer #: 980244 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Speed Citation Date Conviction Date ACD Explanation County IUR 09/24/2009 ?1414 -Fall to Obey Traffic Sign/Signal 52 IA 07/27/2010 _09/28/2009 08/12/2010 592 Speed MO 05/12/2011 05/16/2011 S92 Speed (10. mph & under in 35-55 mph zone) 52 IA 03/04/2012 03/12/2012 -M14 Fail to Obey Traffic Sign/Signal 52 IA Name: Nealon, Sean Francis DL/ID: 433YY0367 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: Nealon, Sean Francis DL/ID: 433YY0367 6/1/2012 IOWA 0. ^ Ste= DRIVER,_= Office of Driver Services Iowa Department of Transportation Name: Nealon, Sean Francis DL/ID: 433YY0367