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HomeMy WebLinkAbout12-172III CIMCCO'N memo% CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX Authorization Number /��- — /72— (Office 72— APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) (Office Use Only) First MiddleI Last 1. Name _C4 r ` �Q(o r -14,"A a Pr?Tll� 2. Mailing Address "t/ sz:—I`'3,.,n L, 41e -v. `f Jl,i -cA 3. Telephone: Home 73 i - '5 5,V — fOther: 4. Prior experience in transportation of passengers: Lw� a Z y.' r s i;. Mn 4 f , 1Z co Ll n e— 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /Lo 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? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? (. . Type of offense Where When 6 �o/l is i is -r. s `�rs'us" redo v L? 8. Has your driver's Ilcens�or c�fiau�feur's license been suspended or�revoked in the last five y�ars? 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) derknaxidnvbadg 06/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number �� b t .� - 1 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,Qi STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me On this d-�� day of SnNC Commission= NumberrVrtr 159791 my coommss9n1EYa�a 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). ao-la Date S!-r?O--/o2- 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. **llfffYkYM###*****1f*ff#4Y#*#k**#**ff11fH##itff*4*t11f*fYffffh####i#****##***If11M11ff###ff*##***#41f11M#f'Y###4###*##***fRRtlkNYt�F#*#*R11f Office Use Only Approved application DCI report State certified driving record Website update clerk iddWadgeapp2010 do 06/2012 CIowa Department of Transportation AW Office of Driver Services (Toll 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: 7/31/2012 DL/ID #: 803ZZ6639 (IA) Name: Pogue, Christopher Michael Class: D Address: 412 N Clinton St #9 Audit #: 3268597 04/13/2011 04/26/2011 Issue Date: 05/01/2009 City/State: Iowa City, IA 52245 Expiration 02/15/2014 Date: Endorsements: 3 Mailing Address: 412 N Clinton St #9 Restrictions: NONE Date of Birth: 2/15/1983 Mailing City/State: Iowa City, IA 52245 Sex: M History Information Convictions Customer #: 5051546 ID Status: VAL DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation bate Conviction Date ACD Explanation County JUR 12/06/2010 01/04/2011 S92 Speed 52 IA 04/13/2011 04/26/2011 S92 Speed 52 IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation JUR 05/29/2003 A61 Under 21 -Alcohol Content .02 but less than .08 IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked 06/09/2003 08/08/2003 A61 Under 21 -Alcohol Content .02 but less than .08 IA IA Name: Pogue, Christopher Michael DL/ID: 803ZZ6639 Pursuant to Iowa Code §321.30, 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: ' pEHICIf °'�y ize IOWA z'4 ICn�f a6NER S-R-�_, Name: Pogue, Christopher Michael DL/ID: 803ZZ6639 7/31/2012 e � j '�k Office of Driver Services Iowa Department of Transportation Aug. 17. 2012 2:55PM Div of Criminal Investigation ICE „J6. ". cvic I<.-r7im viy -IVIn vitt Invest Ivna vii}' ■ ' STATE 1IOWA, 1 1 CriminalHistoryRecord Check Request F1 T To: Town'DivisionofCriminai nvestigatlon Support Operations Bureau, I` Moor 2151;. 7tt' Street Des Moines, Iowa 50319 (515) 725.6066 (515) 725-6000 Fox T am requesting an Totva Crhninal.Histo>yy Record Chock ort: NNo.�9511�9 fP. �1/1 DCT Account Number: (ifeppliceblc) •• 1Franl: CITY017I0WACITY CITY CL)EI C'S OEMCE 410 L. WASHINGTON STRUT IOWA CIT$ XOWA 52240 Phone: 319-356-SO41 Fax: 319356'5497 LAstNOMO(mandatory) First Myna mandeoty) MildleName (rewmmatdoo f 1 G) c�7 rf,—a• Pate of 131rtl2 (mandatory) Gender almdalo ' Social Seentrity Number (recommmded o ,1 /°/ Owa1e female S6/ - -7,7— -7 1 2L WaIVOP,(VOYMaflow Without asigned waiver front the subject of tbarogtwft a complete criminal history MOM Maynot I he releasable, por Coda oflova, Chapter 692.2. T7or complete cOrn nal history record information, as sllo�tyed bylaty, ahvays obtain a waiver s! anature from the suhlect of the rearrest Waiver Release: I hereby 81Ye ponuilslon forrhe above requesting Of6dal to conduct m rowacifminal history rewrd chectcv/lth Ne D1V1s1oh ofCrimtn®1 rnvesRgallon (DQ..Any vlmind hirroty data conwmingme thatis maintained by the DCI may be refemed as ellovcd by [pity. Walmer Iowa Cr 4story Record Check Results Record. Check Results As of70�1' I s snatch oftho,providedname and date ofbirthxevealed: VK No Iowa Criminal hatoryltcoozdFouadwithDC1 © Iowa Criminal HistoryRecord. attached, DCT DCTinitials 1"6_ Received Time Aug. 14.._2012 12:44PM No, 1322 r— W f 1 G) c�7 rf,—a• z— _i7 G— �T xs r— W