The URL can be used to link to this page

Home My WebLink About13-262 we Authorization Number l3 - Loot. 1 (Office Use Only) wow Biz APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (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 Lj A--L LtSn/ / �L-�- 2. Mailing Address 2-YO/ !'h( 0)4L,//w nT/, 14 s--2-zq s--2-z 0 3. Telephone: Home 141-4-( -k`-1 -q C/( . Other: 4. Prior experience in transportation of passengers: \L/ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?' '° '0 Type of offense Where When 6. Have you bee convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? (UO Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 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) 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) • clerk/taxidrivbadg 03/2013 7Y9 4T 3 ss , I hereby certify tha# I ave issued to me by the Iowa Department of Transportation a valid Chauffeur's license number t' Y kJ 3.552 . 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) i '( J Signature of Applicant I / Date 1 1 1/)126/3 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Tfty.,,..e 4, PC, I ate_ . On this 1,`) �1,v day of A 1 d,j e i)-ea " J-0.1_1 .rat41s WENDY S.MAYER 1 < _ z Commission Number 729428 A• My Cen1lniselen Expirew Notary Public in a9. for the State of 4 a ************************************************************************************************************************************************ 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). sil/* ---------------- gnature of Police Chief or designee /7) 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. �� L �x�' /1/ f �(� �1/LJ J 1 i r:.. / :r._:, Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/z" (width)and 5 1/2" (height)and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update clerkitaxidrivbadgeapp2010.doc 03/2013 PAGE 1 PENNSYLVANIA DEPARTMENT OF TRANSPORTATION BUREAU OF DRIVER LICENSING CERTIFIED DRIVING HISTORY OCT 24 2013 DRIVER: JAMES ALLEN BLAKE DRIVER LICENSE NO : 29748730 50 S VALLEY RD APT A3 DATE OF BIRTH : OCT 11 1961 PAOLI, PA 19301 SEX : MALE RECORD TYPE : REG LICENSE DRIVER LICENSE (DL) COMMERCIAL DRIVER LICENSE (CDL) LICENSE CLASS : C CDL LICENSE CLASS . LICENSE ISSUE DATE: AUG 07 2011 CDL LICENSE ISSUED : LICENSE EXPIRES : OCT 12 2015 CDL LICENSE EXPIRES: CDL ENDORSEMENTS : NONE MED RESTRICTIONS : NONE CDL RESTRICTIONS : NONE LEARNER PERMITS CDL LEARNER PERMITS: LICENSE STATUS : VALID CDL LICENSE STATUS : CDL MED SELF CERT : CDL LIC DOWNGRADED : SB ENDORSEMENT MEDICAL CERTIFICATE (MC) PROBATIONARY LICENSE (PL) MC STATUS • MC RESTRICTIONS PL LICENSE CLASS • MC ISSUED PL LICENSE ORIG ISS : MC EXPIRES • PL LICENSE ISSUED . PL LICENSE EXPIRES . SKILL PERFORMANCE EVALULATION (SPE) PL LICENSE STATUS . SPE EFFECTIVE • OCCUPATIONAL LIMITED LICENSE (OLL) SPE EXPIRES • OLL LICENSE CLASS . WAVIER/EXEMPT (W/E) OLL LICENSE ISSUED . OLL LICENSE EXPIRES : W/E EFFECTIVE • OLL LICENSE STATUS W/E EXPIRES • MEDICAL EXAMINER (ME) ME NAME: ME TELEPHONE : ( ) - ME REGISTRY NO: ME LICENSE NO: ME SPECIALITY CODE: ME LICENSING JURISDICTION CODE: *** CONTINUED *** PAGE 2 CERTIFIED DRIVING HISTORY - OCT 24 2013 - LICENSE NUMBER 29748730 CONTINUED REPORT OF VIOLATIONS AND DEPARTMENTAL ACTIONS NO VIOLATIONS OR DEPARTMENTAL ACTIONS DURING THIS REPORTING PERIOD REPORT OF MEDICALS AND DEPARTMENTAL ACTIONS NO MEDICALS OR DEPARTMENTAL ACTIONS DURING THIS REPORTING PERIOD REPORT OF ACCIDENTS AND DEPARTMENTAL ACTIONS NO ACCIDENTS DURING THIS REPORTING PERIOD *** END OF RECORD *** PAGE 3 CERTIFIED DRIVING HISTORY - OCT 24 2013 - LICENSE NUMBER 29748730 CONTINUED IN COMPLIANCE WITH YOUR REQUEST, I HEREBY CERTIFY THAT I HAVE CAUSED A SEARCH TO BE MADE OF THE FILES OF THE DEPART- MENT OF TRANSPORTATION, AND HAVE SET FORTH ABOVE AN ACCURATE SUMMARY OF ALL RECORDS IN THE NAME OF THE PERSON INDICATED. SINCERELY, DIRECTOR, BUREAU OF DRIVER LICENSING SEAL FOR SECRETARY OF TRANSPORTATION COMMONWEALTH OF PENNSYLVANIA SS: DATE:OCT 24 2013 I HEREBY CERTIFY THAT JANET L. DOLAN, DIRECTOR OF THE BUREAU OF DRIVER LICENSING OF THE PENNSYLVANIA DEPARTMENT OF TRANSPORTATION, IS THE LEGAL CUSTODIAN OF THE DRIVER LICENSE RECORDS OF THE PENNSYLVANIA DEPARTMENT OF TRANSPORTATION. AS THE DIRECTOR OF THE AFORESAID BUREAU, SHE HAS LEGAL CUSTODY OF THE ORIGINAL, FACSIMILE, OR MICROFILE RECORDS WHICH ARE REPRODUCED IN THE ATTACHED CERTIFICATION. IN TESTIMONY WHEREOF, I HAVE HEREUNTO SET MY HAND AND SEAL OF THIS DEPARTMENT THE DAY AND YEAR AFORESAID. SINCERELY, 2 ! dam_ BARRY J. SCHOCH, P.E. SECRETARY OF TRANSPORTATION SEAL Noy. 14.. 2013 11•: 02AM DV1iv� of Cr1.iminall)InvestVigatViIotn NNo.T2151 PP. L1/8 �/ ICS... IL V I J IJV 1 111 I. V Y V V .. Y • STATE OF IOWA ANS ILJrr Aptdrd> l 1 ' Criminal History I: cord Check '; .'I.'p ,:: ,,.. ',.'1?lawal` 1l rtjJy3 Request Form ` [ • !zEz ,- - pyh OW DCI Account Number: (iiapp cable) To: Iowa Division of Criminal Investigation From; CITY OF IOWA CITY Support Operations Bureau,l'tFloor CITY CLERIC'S OFFICE 215B.71h Street 410 g WASHINGTON STAMP Des Moines,Iowa 50319 (515)725-6066 IPWA C/TY IoUA-52-2'0 (S15)725-6080 Fax phone: 319-3565041 Fax; 319-356-5497 I=requesting an Iowa Criminal History Record Check on: • Last Name(mending) 11'irst Name(mandatory) Middle Nance(recommended) gz- JM I s 14-2tF/\( Date ofDirt (ma [o ) Gender(manatory) Social Security Number(ecommended) rVIt // VP/ dile demale / / 5.41 05 - Waiverl'r{/Ormnalloltr Without a signed waiver fl'om the subject of the request,a complete criminalhiatory record may not be releasable/per Code of Iowa, Chapter 692.2, For coninlete criminal history record information,as allowed bylaw,always Obtain a waiver signature from thesubicet of the request. • Waiver Releare:lhereby give perm isa nfor ihoa ovoreq Mai offielal to eondoot on Iowa Muria al history record cbcckvriih ibe Division of Criminal Tngatigaaon(c ca. Any&minadhlsWry 6 commis me tha maintained b IhcDClmay be released as allowed bylaw. WaiverSignala.8: 111111mmiNENNER .. WI et-e...„ - Iowa Criminal History Record Check Results (Douse only) As of J ---/4-/—�) , a scotch of the provided name and date of birth revealed: - • No Iowa Criminal History Record found with tICI 0 Iowa Criminal History Record attached,,DCI# . DClinitials9...6 , • Received Lime Nov. 71)10013 1 :29PNr No. 4301