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Home My WebLink About13-114 Authorization Number 19) 1 I -14 (Office Use Only) iirSTaCilaVvi "` nW'w"ga i 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 r 1C�e-ph wr"l��C'.t/ LAS It oL4./. 1,t L 2. Mailing Address ?X WLt l v(,v-f- Si--- 1 ��,�-�) y , -1-A4 S 2 Z '( C 3. Telephone: Home 3(9 .S-9Y o 7v S— Other: 4. Prior experience in transportation of passengers: 4/ç4- 41 W -W41 L✓Lt / /l 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /l/) Type of offense Where When 6. Have you b eRn convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? A4- Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? AA) 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) derk/taxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license_number 127 kG 'f u[ 12 . 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 Date 5 ' ZJ " /3 STATE OF IOWA ) COUNTY OF JOHNSON ) Srygc,ribed and Tore) to before me by OSS pi ``�S��S f�i On this 1 f day of / ( (r- s4(: o ,,,, ��r„KE aLIE K.TU 22E 019 Notary Public in and for the State of Iowa ? . My Co my�sionx it s 4eiow� 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). 0///3 Sign ture of o ice ief 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. Sign ure of Cirk or designee Date Taxi cab businesses ale required to provide Driver Identification cards. Cards must be 8 1/2" (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 derkRaxidrivbadgeapp2070.doc 03/2013 Page 1 of 1 4 Orl II Iowa Department of Transportation Je Office of Driver Services (Toll Free)800-532-1121 it PO Box 9204,Des Moines,IA 50305-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 5/21/2013 DL/ID #: 127AC8472 (IA) Customer#: 5231945 Name: Laskowski,Joseph Class: D ID Status: None Waiter Address: 836 WALNUT ST Audit#: 5981226 DL Status: VAL Issue Date: 05/15/2012 CDL Status: None City/State: IOWA CITY,IA Expiration 04/25/2017 CDL Cert None 522403340 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 836 WALNUT ST Restrictions: Corrective Lenses Restriction None Date of Birth: 4/25/1973 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522403340 History Information Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number ]ug 10/20/2008 {467886 _ IA 09/07/2012 703362 IA Name: Laskowski,Joseph Walter DL/ID: 127AC8472 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: 3 icir `% 4.•• . jwry 5/21/2013 çt '�� ri +. T. CF" OIs Driverof Services Iowa DpartmentofTansportation Name: Laskowski,Joseph Walter DL/ID: 127AC8472 5/21/2013 os/May. 15. 2013, _4 24PM Div of Criminal Investigation ., DCI low No. 3334 PkeT SI/66 6 iv.— _ : STATE OF IOWA -.4,.:,.... Criminal History Record Check '� Request Form <.`. - DCI Account Number: q3f 3(If �t ) To: Ion Division of Criminal levesngadoe e From: Plants-rixI Bepport Operation'Bureau,IN Floor • I � T 5l- Or.tvew0 � . 215 F-r street DelMolou,l60319 (515)725 6a666 OIaA -a9 i LA g- 0. (515)72540A0 FLY Phone: ,(919 338- �N• • Fa=:.. 319 sci--111 Tam requeaUnR an knee Criminal Historyf Hems!Cheok on: - - Last Name(mammy) First NeMosss lseto i Middle N.MO(,emmnsoaed) . 1aslzawS k i ,s.So5e ply - Wc411147 Date of Birth(nacho!) Gender(MNeuory) Social Security Number(moaornaikd) t44 •25,73 dale OFemale Itch C-2 .33027 Waiver bferittathMT Without a slimed salver from the subJed un the request,•complete mended Theory record wryest ho eelgyhle,per Code of Iowa,Cbepter 692.2.For oomnleb eriSal bbtory recent leformeao0,es allowed by MW,always obtain•eraser slg"ettire from the ablest of the request Waiver Release:I em er anew mobilo nonce ebare,w.ati^111a l to masa=ton onmhnl b ne*/mord d ntM1h doINVIalm o[Cnldml Inrrewpeox(DCD.Any nimbi'bison dad 1 bmabrain&ty aanCt may be reload au loosed bytaw. . WaiverSignalore: _. Iowa Criminal History Record Cheek Results Tan)only) As of �1/5—LI,a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with Da I. ❑ Iowa Criminal Hi6foty Record attached, I il DCI initials61-c)DC DCI-77(0545/10) • Received Time May. 9, 2013 11:46AM No. 2650