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Home My WebLink About13-254 .` Authorization Number1 - 5(--/ I 1 (Office Use Only) �-a CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington Strcct 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. NameC!t S -i-,. ri (.� 1 yct/rZ Ah 2. Mailing Address 2 3r) r �� o C / 3. Telephone: Home Other: 3 19- ?c" I '6 3 4. Prior experience in transportation of passengers: J- 1,r) Gk 5 C11./10,6 ( T A j CL t 1Vv r f•� CI3YAM ,? ,.. 1W 4,o`x i 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /(A .-V • `I 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? AJO Type of Offense Where When - z �cA 7 jo.hl(1. 1`) OCf -UCt 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? /(,) o 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) C1 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 • I hereby certify that I ave issue0_.to me by the Iowa Department of Transportation a valid Chauffeur's license number l� 3 k—'J LU . I understand that if I falsely answer any questions in this application, that this application may be denied. I undersand 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) J'� Date//-- )/ - / 1-5 Signature ofApplicar0 - -�� STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ( ,f, 5-t%i x. n yrt_ti 7 ti ►ti . On this I �- day of VVENDYe ,s.uMAY Koala Notary P Q Public in add for the State of I �� Corrw�s �v ^b� • My Commission Expires •4 _ —7—t 7)—j 1p 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). ,_,.1/P .------ - /0/_5 Signature ofiF�451 ce 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. ?1?7 / rr1, fS - _z-47/, .�) /1Signare of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/z" (width)and 5'/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerkltaxidrivbadgeapp2010.doc 03/2013 V f Iowa Department of Transportation Office of Driver Services (Toll Free)80032-1121 PO Box 9204,Des Moines,IA 50396-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 11/1/2013 DL/ID it: 553WW6503 (IA) Customer it: 896121 Name: Oyarzun,Cristina Class: B ID Status: None Address: 2630 Indigo Ct Audit#: 3315762 DL Status: VAL Issue Date: 05/16/2009 CDL Status: VAL City/State: Iowa City, IA 52240 Expiration 09/24/2014 CDL Cert None Date: Status: Endorsements: PS CDL Med None Status: Mailing Address: 2630 Indigo Ct Restrictions: NONE Restriction None Date of Birth: 9/24/1979 Supplement: Mailing City/State: Iowa City, IA 52240 Sex: F History Information Convictions Citation Date Conviction Date ACD Explanation County JUR - _ 02/09/2009 03/03/2009 _592 Speed...__.. - _.__ Johnson: IA Name: Oyarzun, Cristina DL/ID: 553WW6503 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: VfX�CIf p%°a At' G/,p4 11/1/2013 IOWA % >r' esticoa 3i xiit s ` Iowa Department of Driver rtme teryTransportationies Name: Oyarzun, Cristina DL/ID: 553WW6503 Oct. 24. 2013310:49% Div of Criminal Investigation. No. 2612 P. 1 . - �•� cc. c. ivery vi cin vary UI ,vna vl ly nU. 'FUJI f, • �� ; IOWA STATE OF • • ,4ct� yr Sr,( 'ka Criminal History Record Check met G. `1 ,.. >1 Request Form a .:, r• ^,ti DCIAccountNumber; 1/4 -F (If applicable) To: Iowa Division of Criminal investigation prom: CITY OF IOWA CITY Support Operations Bureau,l't floor CITY UMW 8 OFFIOE 215 E.7th Street 410 B WASHINGTON STREET Des Moines,Iowa 50319 (515)725-6066 _a , (515)725-6000 Fax Phone: 3 19-35 65 041 Fax; 319-356-5497 I am requesting an Iowa Criminal HistoryRecord Cheek on: ' Last Name (mandatory) - FirstName(mandaloty) Middle Name(recommended) Date of Efuth(rnandatory) Oender(mandatory) Social Security Number(recommended) . T. '(— '\4R ❑Male ®Female . L/c 3 ^f/ --99 1 1 WaiverIuformafion:Without a signed waiver from the subject of the request,a complete crimlual historyrecord may not be releasable,per Code of Iowa, Chapter 692.11ror complete criminal history record interruatioll,as allowed bylaw,always obtain a waiver signature from the subject of ilio request. WaiverRelease;Thereby give permission for the e%ova requasiIng official to conduct an Iowa criminal history record checkwfth the Dlvlslan of Criminal rnawligation(DCI). My criminal history data content agmethat is maintained by(be DCI may bo released as al owed by law. // Waive,'Signature: .—i /lam . _.. 'i _ ,t;'. se/ )tt 41-14Y Iowa Criminal History Record Check Results (Dois°only) As of 10 k.ak< <3 , a search of theprovided name and date of birth revealed: • . / No Iowa Criminal History Record found with ACI 0 Iowa Criminal History Record attaohed,DCI t! DCIinidals k. Received T mey.0iL?Z/10,013 2: 16PM No, 2289