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Home My WebLink About13-040Authorization Number. /,� 40 (Office Use Only) e �r"III +N ®1�� 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) 3S6-5040 (319) 356-5497 FAX First lddle Last 1. Name S� 2. Mailing Address(oZ I r% E - C� U 10—T x 3. Telephone: Home c31 — g0(9 — 1 O ( Other: 4. Prior experience in transportation of passengers: t4Aj 6::- V�h D /Lt / r r,j -Tcv-X I , "J ?WA "1t;sn 1Doal(l a I_� CT S 2 clv �� t L!C 3 `y2 XAS()c cX I Zl✓v 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? r\J-n Type of offense Where When 6. Have you b en convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 41 n Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? e�— TVpe nof offense Where When b 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /-j 0 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) deMk idrivbadg 09/2012 h - I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number$ �S� Y R S ?S 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 frttte-p ovisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date STATE OF IOWA ) COUNTY OF JOHNSON ) / S rjbed and sworn �before me by -A— `-ie,0 �_ (� On this Z -U0\ day of l � KELLE K. TUTitE _N tarn Public in and for the State of Iowa 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). Sig tui of P6ffce Wief or designee F6. ;7g. .2o13 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. Signature of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update Date denrt NvbadyaapP2010 d 09/2012 AIowa Department of Transportation Office of ®aver Services (Toll Free) 800-532-1121 PO Box 9204, Des Maines, IA 50306-9204 515-244-9124 O FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Data: 2/21/2013 DL/ID #: 555YY8575(IA) Customer #: 4942575 Name: Genell, Sean Peter Class: D ID Status: None Addreea: 1212 E COURT ST UNIT Audit #: 6716923 DL Status: VAL 2 Issue Date: 02/21/2013 CDL Status: None City/State: IOWA CITY, IA Expiration 01/22/2014 CDL Cert None 522403228 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 1212 E COURT ST UNIT Restrictions: NONE Restriction None 2 Date of Birth: 1/22/1973 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522403228 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 03/04/2008 04/09/2008 S92 Speed 52 IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 03/02/2008 431356 IA Name: Genell, Sean Peter DL/ID: SSSYY8575 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: ""..... � �y 2/21/2013 IOWA o; ;c • C? `hOF ......Office of Driver Services �.�� 111 Iowa Department of Transportation Name: Genell, Sean Peter DL/ID: 555YY8575 Feb.22. 2013 8:42AM 02/12/2013 20:18 FAX 0 Diu of Criminal Investigation No. 4 16 3 P. 1 a DCI IOWA IA003 STATE OF IOWA Criminal History Record Check - Request Form To; Iowa Nwhius of C►ImYal love tlptloe Support opetsdoss aarra.10 Floor 215 r. 7a Slroet on Medea, Iowa 5019 (515)72&" (SIS) 12"M Fox u Irr`\ DCI Amount Number: H3gj r FG great (Marcts—Fw s+#,UCAS DIF / oU• A Sai'1v Phone: Fox:.. 311 SS } Leet Neese w.d�uam _ First Name goodowrl MWdle Nese 11~ ll Dem of BIK Gender Social Security Nmmber 1 Z 'L- 19 i Male ❑aemale I 3 3 (� - �Q -14 oS r &%W /IVeMm0j0M Without a etped w Wer INS the oubleet of the regseet, • complete amled hkwy road w5 mot bo rolemble, pne Cade orlows, chapter Ate. For con erhalaal history reeord mdormodoo, av slowed by law, always 9buhl a r h® the cab met of the oat. WehwReiif=*IhaebtMrw�� bre of owdwntowiwhand duck WM"DIVWMarCn lrAl I.,wnNronf� M. Mo' plah8:zMWdea ae DO way be Minimal by Im. wobwSlsAID91W Iowa C 'Juxl History Record Check Results As of a,a a `�� a wareh of the provided name and daft of birth revealed: ._J No laws Criminal History Rwcord tbund with DCI 13 lova Criminal History Record ettaohtd, DCI b DCl initials DCI -77 (08/2VIO) M ..... 1 r:... r.l 19 M10 D. ICIAA 11_ ) I A I