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Home My WebLink About12-1415. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /i n Tvoe 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? h r> Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? c Tvoe of offense Where When 8. Has Our driver's license or chauffeur's license been suspended or revoked in the last five years? Tvoe 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 names) 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) ded idnvbadg 149AXLtO Z— Authorization Number /a— F+ l r l j (Office Use Only) CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington street between 8 a.m. to 3 p.m., Monday - Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name JQ��C' A 1aCk�01�'�. 2. Mailing Address X0.5 (l IAi', (-�+E 3. Telephone: Home 31-- Other: 4. Prior experience in transportation / of passengers: %' )a—S7 14 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /i n Tvoe 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? h r> Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? c Tvoe of offense Where When 8. Has Our driver's license or chauffeur's license been suspended or revoked in the last five years? Tvoe 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 names) 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) ded idnvbadg 149AXLtO Z— r I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number 2 Alp, , -% I ' ; . 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 MMMY#yeiifM#H##f-kM#M*#}*f}}.###M*R***MR11f fR1ff RRf RRf}M#}fF'.YfRMkf*Rf*R}#*#M'kR*}##*#k##iffefMlMlffl1111ffi-##f #YMMM.1fff f#ff#Yk!#### STATE OF IOWA COUNTY OF JOHNSON serib d and swo n to before me by \ e �, C L% -On this ay of �.1— uIAIKELLIE K.TUTTLE K (re- �u .o C' Commission Numhar 971879 Infanr Dnh Iin in nnll for tho 'Z+.+. of Inuro 1 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). g atdfe of Police Chief or designee %172y�.. za/ 7ef• SSiggn re of City Clerk or designee ?6 -/ Z 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. f1MMYf##YM#####*Y#}i#}###}k#}}kRRMRMM*RR*RMIIRRYHMRIIRRMRR*RRR111RR1*RI*!kM*1RfkMi*RHRRR**MkRRMkkRf*RRMRMMRRRRRfM1YMMfYYY#f Office Use Only Approved application DCI report State certified driving record Website update tleiWlaxitlrivbatlgeapp2010 tlac DI� oI` t �01'L Apr. 17. 20122 2:44PN`1 Div of Criminal Investigation "P1. 11• LV 12 7 Y ,JII VII, V I G I A Vllr VI IVwa VI(Y To. Ior AMY/lsiola of CrlminalYnvesttgpt[on Support oporattons aurouu, Tel Vaor Alai„ 7i4 Sfreot DA![Xprzjq)1owa 60319 (819) 719-6166 ' (Sl5) 725-6080 lrarc an No.4713 P. 1/1 no. L)V2 r. L R." STAMOVIOWA.- An Requegt Form DW 1�CIAccount1111mber; y 00-zk•-� • QPepplloeble)^ .l}wuI - CT o -V TowA C T4" •_, CiTY CLTi$R15 MPSCE 4�0 R YJASiirM(TON STRRFT TGWA CITY TON(A 52240 iljoedr M9 -956-•5M 17nY1 __ -419..156-.5/.97 lirnivei` 7 nr/t1uY/atl;WithoutihosubfeatoftharegnesP,igto)n lJWchfmt'nalhlsNryreeordluaynot horalapspble,rorCodaofYown,Chapter 69a,2,Srar o�trpJy�g'orhOnalhtstoryraoordlnformnthw,asaltowod'yt6vG1gfrrays V IWah'er'h4r44yatVepermfssloR tbclhonhove fnYesugavan (OCD. Ntywh!tbelhiscatyaamapnumingmol' own arfminal lilaWtyLaoaat chcckahh IrraAtiaton oecrtmrnor 6orolsasodw nllotrad 4ylnw. Auyr?4 l/4ui&Lu am.IWO LUX V Ai ruU1(A. 'L,,alo4tl Alo,9 W L.°r (DOI pfo only) Ag of a seatoh of tho royMed name and data ofbfx&rowaled, N'aXb�VaCrl�InalHistatyl2ecoYdyoUncitvltliJ>CX ='t'� `" „may ❑ Yom Unifna'Iftlstorgl""0'd DCI iJtillels Received Time'Apr, 11. 2012 4:44PM No,4319 l Iowa Department of Transportation Office of Driver Services (Tail Free) 800-532-1121 PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 7/26/2012 DL/ID #: 822AA2495(IA) Customer #: 454069 Name: Jackson, Jeffery Andrew Class: D ID Status: None Address: 6550 WHITE GATE CT Audit #: 4550758 DL Status: VAL 03/05/2011 03/21/2011 Issue Date: 07/29/2010 CDL Status: None City/State: MARION, IA 523029391 Expiration 06/25/2014 CDL Cert None 10/15/2008 Date: Status: IA Endorsements: 3 CDL Med None Status: Mailing Address: 6550 WHITE GATE CT Restrictions: Corrective Lenses Restriction None Date of Birth: 6/25/1966 Supplement: Mailing City/State: MARION, IA 523029391 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 06/11/2010 06/22/2010 S92 Speed 57 IA 12/09/2010 01/05/2011 S92 Speed (10 mph & under in 35-55 mph zone) 57 IA 03/05/2011 03/21/2011 S92 Speed 57 IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 10/15/2008 467814 IA Name: Jackson, Jeffery Andrew DL/ID: 822AA2495 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: ' ...........;�'%"4 7/26/2012 IOWA¢'' ).O.T.Ws Jam: ......A S= Office of Driver Services' Iowa Department of Transportation