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Home My WebLink About12-2385. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? _ 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?.4,1�) Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 4 Id Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) e6) 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) derkAaaidri&adg 06/2012 °t3 Authorization Number `a'^ l 1 (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 (3 19) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name�C4 0gtltd1 2. Mailing Address C244- r' �2d `4 3. Telephone: Home 7 li Other:� 70 T 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? _ 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?.4,1�) Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 4 Id Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) e6) 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) derkAaaidri&adg 06/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number c9. 2 , yL- f / �� . I understand that if I falsely answer any questions in this application, that this application may be dens . 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 provisjdrls of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) /--\ Signature of Applicant 1. C-.itn � j2L=_ Date f — 47 • STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by �o� A\.y s�.� Sgrd� �,� :, On this S day of ty- 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). &V / -7. ?ora e Date /�.a- /1A 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. Office Use Only Approved application DCI report State certified driving record Website update der to idrimadq app200 do 06/2012 O Iowa Department of Transportation iLA Office of Driver Services (To11 Free) 800-532-1121 PO Bax 9204, [les Moines, to 5030&9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 7/13/2012 DL/ID #; 722XX8565(IA) Customer #: 2815119 Name: Sanderson, Donald Class: D ID Status: None David Address: 90 PHEASANT AVE Audit #: 4485668 DL Status: VAL' Issue Date: 07/06/2010 CDL Status: None, City/State: ATKINS, IA 522069650 Expiration 07/10/2015 CDL Cert None Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 90 PHEASANT AVE Restrictions: NONE Restriction None Date of Birth: 7/10/1949 Supplement: Mailing City/State: ATKINS, IA 522069650 Sex: M History Information CLEAR DRIVING RECORD Name: Sanderson, Donald David DL/ID: 722XX8565 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: /,`pr: •""••:;aj� y� 7/13/2012 b; yCF. Iowa' Office of Dri Name: Sanderson, Donald David DL/ID; 722XX8565 f QR�A St' ver Services Iowa Department of Transportation r - 4Dr STATE OF IOWA ' ' Criminal History Record Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, 1" Floor 215 E. 7`a Street Des Moines, Iowa 50319 (515)725-6066 (515)725-6080 Fax I am renuestine an Iowa Criminal History Record Check on: DCI Account Number: 9861-F (if applicable) From: City Clerk'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) Sal'ulr-<-On / ' G/' c/i/ r/ r Date of Birth (mandatory) Gender (mandatory) Social Security Number (mandatory) k - Cf �' L Male []Female (' G/ 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 story record check with the Division of Criminal is by DCI be u,//allowed bylaw. Investigation (DCI). Any criminal history d ce mg me that maintained the may released Waiver Signatur1,A Date `f C �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 DCI -77 (08/25/10) (DCI use only) f Single Contact License & Backgrouri Results Criminal Historf Background Check Last Name Maiden Name First Name DOB SSN Selection Criteria Sanderson Donald 1949 -July -10 484640576 Results Not found in Database Background Check Complete As Of 8/27/2012 10:48:18 AM 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 $224.00 Generate PDF Search Again https://www.iowaonline.state.ia.us/SING/SINGSQLProcess.aspx 8/27/2012