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Home My WebLink About12-1435. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? N 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? ND Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? AJci 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 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) deMwidrivbade 06/2012 Authorization Number ya-�ir3 % 1 (Office Use Only) A moos .Y�_ ■ 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 Cit ,Iowa 52240-1826 7�a-7 (319) 356-5040 rT; (319 356-5497 FAX First Middle Last 1. Name PS 2. Mailing Address 1'a -al �%`( <,? Coca 1 lie = �. �aay( 3. Telephone: Home ;�t9 %55 880'21 Other: 4. Prior experience in transportation of passengers: /�4,�_ rir.'�c n %(bow �4cr cr hu.wecS k'c- -N-r_ Gc-r•� me ce -l-;r,es 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? N 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? ND Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? AJci 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 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) deMwidrivbade 06/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number -1 It* XX Tr.',R4i . 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 v2 7.& Pe 32 ?012 STATE OF IOWA ) COUNTY OF JOHNSON ) Subao beO and swore, to before me by �J r --J On this 3D -H- day of V £>I -2-- sa t o KELLIE K. TOME c-- L, -f- � t� o commission Number 22191 otary Public in and for the State of Iowa ow 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). SignatutWof Police Chief or designee SignAture of City Clerk or designee Date 7 -31 -ice 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. t##*t*ifftf4ff4fffiit###****fft1ff1111######***#tt4*t**ff*4Yf4ffiff#f#f#4####***#i**t#t*I*tftiff111111111#f##4f*##***i**tt#Mfl4#hi###4*#*****#* Office Use Only Approved application DCI report State certified driving record Website update dannaxidn�bad,�pzoio.a 06/2012 CIowa Department of Transportation AO Office of Driver Sorvl ces (roll F roe) 800-5321121 PO Sox 0204, Des Mangy, IA 50306-0204 515-2.4-9124 FAX: 515-239 1837 Mailing Address: 1227 2ND ST Mailing CORALVILLE, IA City/State: 522412925 Endorsements: 3 Restrictions: Corrective Lenses Date of Birth: 8/23/1985 Sex: M History Information CLEAR DRIVING RECORD Name: Jones, Bryan Dean DL/ID: 716XX9388 CDL Med Status: None Restriction None Supplement: 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: yi9lCif 'rn 7/20/2012 �OWA D. O.T.:y ti.,..r:a fx MT, office of Driver Services Iowa Department of Transporation Name: Jones, Bryan Dean DL/ID: 716XX9388 Certified Abstract of Driving Record Inquiry Date: 7/20/2012 DL/ID #: 716XX9388(IA) Customer #: 4132943 Name: Jones, Bryan Dean Class: D ID Status: None Address: 1227 2ND ST Audit #: 6110557 DL Status: VAL Issue Date: 07/10/2012 CDL Status: None City/State: CORALVILLE, IA Expiration Date: 08/23/2014 CDL Cert Status: None 522412925 Mailing Address: 1227 2ND ST Mailing CORALVILLE, IA City/State: 522412925 Endorsements: 3 Restrictions: Corrective Lenses Date of Birth: 8/23/1985 Sex: M History Information CLEAR DRIVING RECORD Name: Jones, Bryan Dean DL/ID: 716XX9388 CDL Med Status: None Restriction None Supplement: 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: yi9lCif 'rn 7/20/2012 �OWA D. O.T.:y ti.,..r:a fx MT, office of Driver Services Iowa Department of Transporation Name: Jones, Bryan Dean DL/ID: 716XX9388 .Jul.30. 2012 10:00AM Div of Criminal Investigation Jul.23. 2012 2:04PM City Clerk — City of lolva City IOWA STATE Or 'j �•'^�ei:' C�1uwn �t CriminaltRecord Imo• I -,I+.}.��• R�q o To; Iowa Division ofCrlmhtallnvestlgaLloo Support OperatiensFureau, V' p'taor 215 ]r. 7'h Street Des ]Moines, Iowa 50319 (515)725.6066 (515) 725-6080 Fax Tam remlestiva nn Tnwa (,r1rn1uA1 Risto v lteoerd Check on: No. 6028 P. 5 No. 2619 P. 2 DCIAccounENumber; =hod - r - (if epp1(nblc) From: CITY OFIOWA CXTY CITY CL1rRX'S OFMCF, 410 2;, WAS)II NGTON STILPM IOWA CITY IOWA. 52240 Phone: 319-356-5041 Fax; 319356-5497 14st Name (mandaimy) First Name (mandatory) Middle Name (recommended) eS Date of Birth mandrlo Gen (mandatop0 Soelal Security Number recomnunda0 t!�t -,QZ ^ izgMgal ❑Fomale 5 - I l -62 7 -Z WaiverY101'mation: Without a signed waiver lYom the subJ00t of the request, a complete criminal history record may hot be relensnble, per Code of Tow'a, Chapter 692.2. Fol' com lot cl IminaT history record Information, as allowed by law, aivc'a)'s ob(aiu a Wolver•si nature from the subject of the request. . WaIVeY Reiead'e; l In reby giYo pemdssfoa r011116 6bove Iowa e(hninal hhmryrecord checkwhh dlo DIVlsieh afCominel rnvesdgation (D C)). Anyc(minai history data eollbamIng me dial Is malnmalntalned by the Mi may bo rcleascd as allowed bylaw. Waioer Signn(uYs; X41y II a C�•iminal Mstox R�2ecoxd Check Aesu is As of I iI l:71 a searoh of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCI ❑ Iowa Crlminal History Record attaccheedd,, DCT I DCTinitials (L. Received Time7'Jul.23.1(2012 2:04PM No -0091