The URL can be used to link to this page

Home My WebLink About13-287 Authorization Number /-1 - 217 r 1 (Office Use Only) ..- CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 4 1 0 East Washington Street between 8 a.m. to 3 p.m., Monday—Friday.) Iowa City, Iowa 52240-1326 (319) 356-5040 (319) 356-5497 FAX F'rst Middle - as 1. Name 7051'11 d ( i II LC1 2. Mailing Address /3-1-3fi 1:1-)OCJ\ct 5K. a 3. Telephone: Home ? 9T \'I -LI I U Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? I V 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? t() Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? U Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? F Type of offense Where When• `(/ vv on ' Da Ni � uaA . /A_ 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the na e(s)/U3 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerkitaxidrivbadg 03/2013 ; I hereby c rtify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number LpLi I 1.7i . 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 1 IL 2" � piLLLDate 41 t:` 1 l ************************************************************************************************************************************************ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by l' (._,l' (._, s�, . , o\\ � O , . On this u day of C \JLC vv� .,.- D, o 1 _3 . 'tdotary�'F ublic in and for the State of Iowa 113 rt 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). • i 41'4 Sign re of P.'' -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. -/-4 _.‘„,.,..„ e. .„,..,, /7 ..30— � /. Signare of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/2" (width) and 5'/2" (height)and prominently displayed to all passengers. *****************************************************************•.****************************************************************************** Office Use Only Approved application DCI report State certified driving record Website update clerk/taxidrivbadgeapp2010.doc 03/2013 • • • • IOWA DRIVER LICENSE •J: A 1 _ 10-77-73-17?-6,-YroPOLLION ROSHIDA TANISHA - "44.7 r L -4 335 DOUGLASS C k lifat:kk I W A CITY,IA 2246 691AJ 1970 , iss 12/20/2013 EXP 01/4 bI2014 " 7"-Noie. -47'. Class D End 3 !ill Sex s Restrictions y 1 Hot/44%74" t„tt Eyes BRO 8 DONORY , DOB 09/06/1979 3MED ALERM DD 776283509PRO941F060918D . ' • • • • • • • • • • rage 1 0I 2 Iowa Department of Transportation a. Office of Driver Services (Toll Free)800-532-1121 PO Box 92114,Des Moines,IA 593D5-9204 515-244,9124 NisFAX.515-239-1837 Certified Abstract of Driving Record Inquiry Date: 11/15/2013 DL/ID#: 691471970 (IA) Customer#: 6024489 Name: Polllon, Roshida Tanisha Class: C ID Status: VAL Address: 335 DOUGLASS CT Audit#: 7295359 DL Status: VAL Issue Date: 08/30/2013 CDL Status: None City/State: IOWA CITY,IA Expiration 09/06/2018 CDL Cert None 522465403 Date: Status: Endorsements: NONE CDL Med None Status: Mailing Address: 335 DOUGLASS CT Restrictions: Corrective Lenses Restriction None Date of Birth: 9/6/1979 Supplement: Mailing City/State: IOWA CITY,IA Sex: F 522465403 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 05/22/2012 ______ 08/28/2012 jB51 No Driver's License ohnson [IA 10/24/2012 11/07/2012 1864 No Insurance Card Jones jIA Sanctions Type Effective End ACD Explanation Occurrence JUR ]UR Suspended :01/23/2013 06/05/2013 jD53 Non-Payment of Iowa Fine ;IA IIA___ Suspended 08/09/2013 08/13/2013 11753 1Non-Payment of Iowa Fine jIA [IA _ Name: Polllon, Roshida Tanlsha DL/ID: 691471970 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: • ' *WCfpI ,cir ••.h , 11/15/2013 a / IOWA .?a *: :a. =W 's:,D O. T. le Office of Driver Services I\hi Iowa Department of Transportation 11115/2013 Dec. 3. 2013 10 : 18AM Div of Criminal Investigation AANo. 3686 P. 1/1 .1VU v. 'L!, LUIJ LTJ IVI l- I ly td Lllr u LVTI bI / 11'V. `f IUU P. L y °Fr <,,;... STATE OF IOWA ,,,`` ';`< r \� Criminal History i"ecor�d Check y .P.,k,�r'J1•`r/ Request Form f a ter,, ''Qa` ,, DCI Account Number: 1/60 `"F. (if applicable) - To: Iowa Division of Criminal Investigation From: CITY OF IOWA CITY Support Operations Bureau, 1"Floor CITY CL RK'S OFFICE 215 E.Th Street 410 E WASHINGTON STREET Des Moines,Iowa 50319 (515)725-6066 o. , _ . , __ (515)725-6080 Fax /hone: 319-3565041 Fax: 319-356-5497 I em requesting an Iowa Criminal History Record Cheok on; ' LastNawe(mandatory) Fik'StName(manda(ory) Middle Name(recommcndcd) • potlib ,,-) p'o�� L CV- art t hpt I Date of Dirth(mandatory) Gender(mandatory) Social Security Number(recomrnanaed) - ci •6 - I C 7 9 :Wale denage S Xl. - (og ^ UL Waiver Iriformalion: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 comuleto criminal history record information,as allowed by law,always obtain a waiver algnaturo Irma the subject of the request. Waive) Release;Ihereby give permission fbr Iho above requesting official 10 conduct pn Town erlminel history record check with the Division of Criminal Investigation(DCi). Any crlminel history data concerning me that la maintained 44, /by tthhe DCI may ha released as allowed bylaw, Waiver Signature: t/`i Iowa Criminal History Record Check Results (DCI use only) As of /at '5 (_ , a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCI 0 Iowa Criminal History Record attached, DCI# DCX initials 0.._ . . r Received TinerNov. 21. 02013 12: 29PM No. 3417