The URL can be used to link to this page

Home My WebLink About18-025 IDENTIFICATION NO. (F2 —Q Z3 h (Office Use Only) szO ::�i Ff826z018 'i'mi®'la C how city Clerk APPLICATION FOR TAXIC`Ai 1 MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday—Friday) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX Fist Middle Last 1. Name(REQUIRED) / ' éZ zi9k 2. Address (REQUIRED) 3.2' LE/3500 i AWA G 11 2 5 Z 2.5+0 3. Contact Information (REQUIRED) Email: /nS EA,-Les /)2 J, Co.r. Cell Phone: g/9-17"7/-49175— (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) /e1/6P4/8 b. Taxicab Business Name (REQUIRED) P Lib 5. Prior experience in transportation of passengers: Cues 01#414-", 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested/charged with any traffic offenses in the last five years? Type of offense Where When .1,;//ow4t, 7404 2 ✓ .75,J �QJ7 . What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspendedlead G Other 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER 4 ` Paget FEB 2 I hereby certify that I have issued to me by the Iowa Department ofZnsportation a valid Driver's license number 2T4' P`e`74 issued on 4/9/ `expiring on /i6/2O f,' . I understand that if I falsely answer any questions in this application, that this appl n?rt y be denied. I agree that in making this application, I consent to allow agents or employees of the City of Iowa City, Iowa, iii th ?/eliscretion, to examine any and all records and documents relating to this application, and I further agree that, if authorization to be a taxicab driver 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 Applican ..-y G! Date-/A 3/ Zovr ****************************************************-k************:t************************ *****x**************,tart********roti.***,***********+*r STATE OF IOWA COUNTY OF JOHNSON ) Sub cribed and sworn to before me by \ A\\•z‘.h `��'``�e on this day of -6.V.A.)Sy 0 �. Pu lic in and for the State o Iowa "?13 VI-° ************************************ *************************,*****************,***,***************************************************** I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City(Title 5, Chapter 2, City Code). Expiration da ri s license 06`/G7 - ``p 7 Signore of Police Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Sig ature of Cityler or designee Date ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update ClerIVTAXIDRIVBADGEAPPL92014amended.DOC 07/2016 reb. l9. 1018 8: 38AM Div of Criminal Investigation No. 4125 P. 1/3 02/18/2018 14:56 Yellow Cab A,0319 338 2708 P.0021002 a� O71" . . 0 a, . ' ' • •ti;�r`t„•_.,, ,i,,,,, ,i,,,,., .Yo: : ;y- , STATE OF XO & i --�= ��\., ;''.i':... .:,...:.,-4.,;:;Y�.;< }' ; � Criminal History Record Check . ;: . .i ., moi` ' ,i_,c :.•..;; ,.: Request Form ,s � 'Zr DCI A000unr Number: 9967-F (irapplicablr) To: Iowa Division of Criminal Investigation From; Yellow Cab ofIowa Cites_ SupportOperations Bureau, 1'i Floor 'P.O.Box 428 215 E, 7'Street Dos Nfolnes,Iowa 50319 - (515)723.6066 Iowa City,JA. 52244 (515)725.6080 Fax - (319)338-9777 • Phone: • Fax: (319)339•-7302 1 am requesting an Iowa Criminal HistoryRecord Cheok on: Last Name tma decor First Name(mandatorr) ' • Middle Name(recommended) a, 4.4.5 lGNAc.C. . A 1.-.4.A#I Date of Birth (mandatory) .Gender(mandatory) • Social•Securi fr Number(reeomzeendw) • G /��SG �11'[nle ❑ exuale '�S2 u'y a Waiver Information:Without a signed waiver from the subject of the request,a complete criminal history record may not • be releasable,per Code of lows,Chapter 692.2.For complete criminal history•record information,as allowed by law,always' • obtain a waiver signature from the aublect of the request. •. Waiver Release:I hereby give pcmdssion for the above requesting official to conduct an'Iowa criminal history record chock with the Division Of Criminal. • . Inveadgedon(DCI). Any criminal history date concaming mo that Is melnulned by the DLI miy be released 45 allowed by law, Waiver Signature: Z. - ' Air . • . • Iowa Criminal His1`Qry e_gpl(-d C)eck Results . _( DCluse only) • AS of _ , a search of the'provided name and date of birth revealed'.. - L--;r1 t No Iowa Criminal History Record found with DCT ci'13 ' .`i c-, l .1 i. 0 Iowa Criminal History Record attached,DCI ii. • • • ' DCI initials,C • • DCI-77 (08/25/10) • • • Roroivod Timo PO) IA 1A1A 1•44PM Nn 49)1 efl fIN Iowa Department of transportation c83 Oboe at Driver SeMces ,Fres)800-632.1121 PO Box 920Moines, 4,Des IA 50005-9204 -0P JO515-2444124 NOP FAX 515-239-1037 Certified Abstract of Driving Record Inquiry Date: 2/16/2018 DL/ID#: 228AD8474 (IA) Customer#: 687190 Name: Earles, Michael Allan Class: A ID Status: None Address: 32 GLEASON DR Audit#: 7084993 DL Status: VAL Issue Date: 06/29/2013 CDL Status: ELG City/State: IOWA CITY, IA Expiration Date: 06/16/2018 CDL Cert Status: Non-Excepted 522405838 Interstate Endorsements: NONE CDL Med Status: Not Certified Mailing Address: 32 GLEASON DR Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 06/16/1956 Mailing IOWA CITY, IA Sex: M City/State: 522405838 CDL Medical Examiner's Certificate Certificate Specifics Explanations Medical Examiner First Name Jeremy Medical Examiner Middle Name Lewis Medical Examiner Last Name Nelson Medical Examiner License Number 002023 Medical Examiner National Registry Number 7661525813 Medical Examiner Jurisdiction IA Medical Examiner Phone (319) 358-5736 Medical Examiner Type Physician Assistant Medical Certificate Issued Date 11/16/2015 Medical Certificate Expiration Date 11/16/2017 Date Added to CDLIS Driving Record 11/17/2015 CDL Downgrades Effective End Issuing JUR 01/15/2018 IA History Information . -in , . . . ..r, ••••• 0 . (1 s r Convictions 0a. r-/ lin C) CP l Citation Date Conviction Date ACD Explanation County CO ., WO 03/08/2017 _04/03/2017 593 Speed Johnson IA VD 04/08/2017 05/03/2017 F04 Seat Belt Violation Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 03/08/2017 972671 IA Name: Earles, Michael Allan DL/ID: 228AD8474 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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: , 2/16/2018 allè !± �+i \ e," VD. , Office of Driver Services Iowa Department of Transporation Name: Earles, Michael Allan DL/ID: 228AD8474