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Home My WebLink About12-2441 r �r"III +. M"Im 1�� 't.Illi� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (/pan is 2. Mailing Address Selwl" o le Authorization Number 9) — °2� I (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 3. Telephone: Home 3/O3�%�l,%�� Other: 4. Prior experience in transportation of passengers: L%/Y�o✓ f e .5,-110/6 2. TA 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /v Type of offense Where When Pu3/t� u�Y�,;Jto� c2 iay- 1559 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?L(/fL Tvpe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /6 /e�' Type of offense Where When 8. Has your drivers 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) '4i 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) derF/ mdnMadg 09/2012 I hereby cert a �� i!!ued to me by the Iowa Department of Transportation a valid Chauffeur's license number' d I understand that if I falsely answer anv questions in this 2DDlication. 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 /(�JG �G�'j/Y�ClGrd Date e --Z' STATE OF IOWA ) COUNTY OF JOHNSON ) s ribe and sworntQbefore me by ol � T . KEWE K. Ti On this day of ztsts 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). Fureof �IVChief or designee ,5 r /G -11-x, Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CIN CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at Icgov.org. k. 9�2 r r� /0—//— /02 Sign lure of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update d�manm 201o as 09/2012 Iowa Department of Transportation Office of Driver Services (Toil Free) 800-532-1121 PO Box 9204, Des Moines, [A 50306-9204 515-244-9124 tFAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 10/11/2012 DL/ID #: 330WW2302 (IA) Name: Gorman, Dennis Eugene Class: D Address: 1620 SEMINOLE AVE Audit #: 3704734 NW APT 8 Issue Date: 09/16/2009 City/State: CEDAR RAPIDS, IA Expiration 09/10/2014 524052372 Date: Endorsements: 3 Mailing Address: 1620 SEMINOLE AVE NW APT 8 Mailing City/State: CEDAR RAPIDS, IA 524052372 Restrictions: Corrective Lenses, Left Outside Mirror Date of Birth: 9/10/1956 Sex: M History Information CLEAR DRIVING RECORD Name: Gorman, Dennis Eugene DL/ID: 330WW2302 Customer #: 3813918 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, 1, 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, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: ::••^.;!4j'4� •IOWA 10/11/2012 D. 0. T. Of ••••••''S Office of Driver Services Iowa Department of Transportation Name: Gorman, Dennis Eugene DL/ID: 330WW2302 M STATE OF IOWA Criminal History Record Check Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, 1" Floor 215 E. 7" Street Des Moines, Iowa 50319 (515)725-6066 (515)725-6080 Fax T - ..d;— - T--. Aicfn , PP,n,A rhPrlr nn• 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) O f -/f1410 12 eY/ i5 — i,, Date of Birth (mandatory) Gender (mandatory) SocialSecuritySecurit Number(mandatory) RMale ❑Female 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 lav, always obtain a waiver signature from the subject of the request. Waiver ReteaSe: 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 is maintained by the DCI may be released as allowed by law. Waiver Signature:�� /��f y✓ Date 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 -77 (08/25/10) DCI initials (DCI use only) ,G Page 1 of 1 Single Contact License & Background Check Results Criminal Histor f Background Check Last Name Other Last First Name DOB SSN Name Selection Gorman Dennis 1956 -September -10 481768229 Criteria Results Not found in Database Background Check Complete As Of 10/11/2012 11:59:22 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 $1189.00 Generate PDF Search Agatn https://www.iowaonline.state.ia.us/SING/SINGSQLProcess.aspx 10/11/2012