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HomeMy WebLinkAbout12-2345. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? rl O 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? ?J p Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? C134� /`JJ.Sl9 ( I&ISA%(\V, SO Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N O TVpe 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) derMA idriWm$g 09/2012 Authorization Number /3 - 134 t r t (Office Use Only) III CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington Street between 8 a.m. to 3 p.m., Monday— Friday.) Iowa City. Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name V\C N © K TE C 1✓Tt= TE G rz7E 2. Mailing Address S W A e -C �� \G 3. Telephone: Home �31 q i 5 1- (, 3 (, Ct iSL9� Other: 4. Prior experience in transportation of passengers: �k .1 Ivi " r" (-�_ -\ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? rl O Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? ?J p Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? C134� /`JJ.Sl9 ( I&ISA%(\V, SO Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N O TVpe of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the names) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report (form available upon request) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) derMA idriWm$g 09/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number C 1 --A R N -;k 4 5?; . 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 !!ki!'GGTS/ CQ�9 Date 0 Q /Z �) Z NR3RRlRffR!!4#Yf #4NN##NN#*INRRRf1fi11f Nffif41N41Y41NNYNIN#N#N##RR#!#R#RNRRR}RRRf#ltRRkifffRfffNRff N1fff f4NfNfNNk*f Y##R##RRf STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Nsno(<-/ 71..e On this day of S.,, doiI - -- ---�� in and for the State of Iowa ***##R#Rk#i*ktii#t333Yt#R#R}*#**N**Rk**kiii###RA33N4334k3RRR#R#RRRRR#*#*R###}*##}#*R##***k*}#*#N***k#*N*#**3*k#Hikkki#3#kkik#ik#3RkR#R#*k** 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). SignA'�_� t re of P61ice Chief or designee Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. llrLC�t2t/ � . 91�C//7i1/ Signa re of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update Date d mnmad2010« 09/2012 F,. D994o-D, STATE 4h �► ,�ry� dmf () F IOWA CriLI 1 Sof` t• K�i� X Request Record 1 11 `C7/CFf _PLS To: Iowa Division of Criminal Investigation Support Operations Bureau, 1't Floor 215 E. 7tb Street Des Moines, Iowa 50319 �0�� (515) 725-6066 (515) 725-6080 Fax T nm rennegtino an Tnwn Criminal T4igtnry Reenrd Check nn' DCI Account Number: 9861-F (if applicable) From: City Cleric's Office City of Cedar Rapids 101 First Street SE Cedar Rapids, IA 52401 Phone: 319-286-5060 Fax: 319-286-5130 Last Name (mandatory) First Name (mandatory) Middle Name (mandatory) Tt GETS V\eNOK Date of Birth (mandatory) Gender (mandatory) Social Security Number (mandatory) ©C' Az OMale ❑Female -7-5 1 — 635 0 Waiver Information: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed by law, always obtain a waiver signature from the subject of the request Waiver Release: I hereby give permission for the above requesting official to conduct an Iowa criminal history record check with the Division of Criminal Investigation (DCI). Any criminal history data concerning me that ismaintained by the DCl may be released as allowed by law. Waiver Signature: Date 08/� J Z Iowa Criminal History Record Check Results As of , a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached, DCI # DCI initials 77 (DCI use only) SING Page 1 of 1 s. Single Contact License & Background Check Results Criminal Histor r Background Check Last Name Maiden Name First Name DOB SSN Selection Criteria Tegete Henok 1986 -June -18 756016350 Results Not found in Database Background Check Complete As Of 8/20/2012 2:36:42 PM NOTE: The first and last names, date of birth, and SSN displayed in the abuse registry and criminal history results are just as they were entered on the screen. Billing Account 9861-F Cash Deposit Currently at $509.00 Generate PDF Search Again https://www.iowaonline.state.ia.us/SING/SINGSQLProcess.aspx 8/20/2012 Iowa Department of Transportation Office of Driver Services (Toll Free) BDO-532-1121 PO Box 9204, Des Maines, IA 50305-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 9/18/2012 Name: Tegete, Henok Ketema Address: 318 66TH AVE SW APT 16 City/State: CEDAR RAPIDS, IA 524045385 DL/ID #: 617AH7458 (IA) Class: D Audit #: 6177458 Issue Date: 08/02/2012 Expiration 06/18/2017 Date: Endorsements: 2 Mailing Address: 318 66TH AVE SW APT Restrictions: NONE 16 Date of Birth: 6/18/1986 Mailing City/State: CEDAR RAPIDS, IA Sex: M 524045385 History Information CLEAR DRIVING RECORD Name: Tegete, Henok Ketema DL/ID: 617AH7458 Customer #: 5873120 ID Status: None DL Status: VAL CDL Status: None CDL Cert None Status: CDL Med None Status: 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: Name: Tegete, Henok Ketema DL/ID: 617AH7458 9/18/2012 41;;v0"4<- Office of Driver Services Iowa Department of Transportation