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Home My WebLink About13-022i r'II s CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX First 1. Name l�tM %0.„'; 2. Mailing Address 1 69p -1 '>1 3. Telephone: Home '31 —13 (a — l ; 4. Prior experience in transportation of passengers: Authorization Number 3 — a APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Other: (Office Use Only) 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? u 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? AA Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? �e i Type of offense Where When 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When ��uro0� �'tiS;tna (6u�+y Sa Skr TA- 0ao 17.01D e -UW., C C I f k C T�1 I�h.l '#�n \/VP:c .n �A .d.M n��r v Z Juf 0 ! !i. °J 1 -4,3 II 9. Have you ever applied to be an Iowa 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) d�dnw d9 09/2012 I herIyrcertity that 1 I?ve issued to me by the Iowa Department of Transportation a valid Chauffeur's license number A i 3U . . 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 "es wit l> all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) ( / A Signature of Applicant Date U 9 106113 HRf#fY#######*RRR*R4!#RIf1HH#YYR##4##H*R*H**#-*R#4441#1H11IHlffH#YHH#*H###***H4HHR11HRHf#HHHHHH#**R1e#*HHI*RHHHYHH#Yf STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by _?L# d rcy4. n b r; I l; n 4 On this 8 day of Ilk SONDRAEFORT F"' 0 Commission Number 159791 S^ �- M� Notary 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). /J Signature re POICeCh1 0r designee 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. Signafttre 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 -Alf / _� / Date men idmbaeappmiodo« 09/2012 Iowa Department of Transportation (To,, Free) 800-532-l12l Office of Dm er Services 515-244-9124 PO Box 9204, Des Moines, IA 5030"204 FAX: 515-239-1837 History Information Convictions 1/22/2013 of Driving Record County - n Dat®.._,,._-,-------'-.-_"'...'"'""'"-.^.�.. Conviction Date ACD Explanation___.,,..,_,,,..._... ----M------^-' B51'.No Driver s License..,.,,„,„....... »-----^-- Certified Abstract 2008 F .02115/2008.,,„__„__ M70 ;ImproperPassing-.. _.._..._ _ ..___.. `- ,52 2010 _ ;05/12/2010_,.__.�---- Fail to Obeybey TriSignal Customer #: 3727257 03/17/2011jM14 1/22/2013 DL/IU #° 185AD6305 (IA) ID Status: VAL Inquiry Date: Drilling, Benjamin Nash Class: D 5783389 DL Status: VAL Name: 2142 DAVIS ST Audit #: 02/07/2012 CDL Status: None Address: Issue Date: CDL Cert Status: None IOWA CITY, IA 522405813 Expiration Date: 01/02/2014 CDL Med Status: None city/state: Endorsements: 3 Restriction None Restrictions: Corrective Lenses Supplement: Mailing Address: 55 REGAL LN Date of Birth: 1/2/1978 IOWA CITY, IA 522406765 Sex: M Mailing City/State: History Information Convictions 1/22/2013 IOWA --An County - n Dat®.._,,._-,-------'-.-_"'...'"'""'"-.^.�.. Conviction Date ACD Explanation___.,,..,_,,,..._... ----M------^-' B51'.No Driver s License..,.,,„,„....... »-----^-- µ 5? ..""'." 52 2008 F .02115/2008.,,„__„__ M70 ;ImproperPassing-.. _.._..._ _ ..___.. `- ,52 2010 _ ;05/12/2010_,.__.�---- Fail to Obeybey TriSignal �ntt 03/17/2011jM14 ]UR Name: Drilling, Benjamin Nash DL/ID: 185AD6305 Kiln Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am Pursuant to Iowa Code §321.10, I, Ki i accurate copy of an the said custodian Iofflce,and that I have beendauthorizedlby the Director of the IowatDlepartment of T ansportation to so certify. official record currently in the custody of by the ce of Driver Srvices that at Ankeny, Iowa this date: In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, , =t.!'1q 1/22/2013 IOWA --An D.O.T.' - Of Office of Driver Services •....�' Iowa Department of Transportation Name: Drilling, Benjamin Nash DL/ID: 185AD6305 STATE OF IOWA Criminal History Record Check Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, I" FIoor 215 E. 71h Street Des Moines, Iowa 50319 (515)725-6066 (515)725-6080 Fax T am .em,rsfinn nn Tnwn C'.riminnI Tiffs riry Rnnnrd Check nn' DCI Account Number. 9861-F- (d:'applicable) From: City Clerk's Office City of Cedar Rapids 101 First Street SE Cedar Rapids, IA 52401 Pbone: 319-286-5060 Fax:. 319-286-5130 Last Name (mandatory) First Name (mandatory) Middle Name (maudaiory) Date of Birth Aandataiy) Gendemandamry) Social Seeuri ' Number (mandatory) J. DZ LlMale ❑Female '! �R 'Qb —6Z2l Wriiper lnfoimation: Without a signed waiver from the subject of the request, a complete criminal history record may no be releasable, per Code of Iowa, Chapter 692.2. For roto fete criminal history record information, as allowed by law, always obtain a waiver sit natnre from the subject of the request Wziper Release: Ihereby givepe�iss Mbr abovemqu sting ofhcialto conduct an Iowa criminal history acwrd check with the Division of Criminal , Lrvesfigalion (DCI). Any criminal history data to gmc that is by lheDCl may be released as e0owed by]aw. Waiver Signature D¢te al Z z 13 Iowa Criminal History Record Check Results (DCI use only) . As of a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI ❑ Iowa CriminalHistory Record attached, DCI # DCI initials DCI -77 (08/25110) SING Page 1 of I Q� Single Contact License & Background Check Results Criminal History Background Check Last Name Other Last First Name DOB SSN Name Selection Drilling Benjamin 1978 -January -02 479960229 Criteria Results Further research is required. Please await DCI's final response for criminal history. Please note: There maybe multiple individuals with similar search criteria, requiring more research. Background Check Complete As Of 1/2212013 2:33:44 PM NOTE: The first and last names, date of birth, and SSM displayed in the abuse registry and . criminal history results are just as they were entered on the screen. Billing Account 9881-F Cash Deposit Currently at $1529.00 Generate PDF https://www.iowaonline.state.ia.us/SING/SINGSQLProcess.aspx 1/22/2013 aan.Lo. zvlJ 7:tlNm uIv of uriminal invesilgaiion Submitted 2013-01-22 14:33:44.840 IOWA RECORD CHECK REQUEST To: Iowa Division of Criminal Investigation Bureau of Identification 215 E. 7th Street Des Moines, IA 50319 (515)725-6066 (515)725-6080 (fax) REOUE$T (� indicates a required field) I am requesting an Iowa CRIMINAL HISTORY record check on: NO. NOV r. 1/L Page 1 of 1 ACCOUNT NUMBER: 9861-F CITY CLERK - CITY OF From: CEDAR RAPIDS 3851 RIVER RIDGE DRIVE NE CEDAR RAPIDS , IA 52402 Phone 319-286-5060 Fax 319-286-5130 Contact Preference: F DRILLING BENJAMIN NASH Last name* First name* Middle name NO Maiden/Other Last name Volunteer 1/2/1978 M_ 479960229 Date of Birth* Gender* Social Security number* (DCI use only) RESULTS As of 128/2013 8:59:57 AM , a name and date of birth check revealed: CCH Record Attached 7i DCI # 751797 No CCH Record Found. DCT initials Waiver on File_.yes I hereby give permission for the above requesting official to conduct an Iowa criminal history record checl with the Division of Criminal Investigation. Any information maintained by the DCI may be released as allowed by law. Received Time Jan.28. 2013.9:22AM No.2145 Odll. L0. LVI) 7.L7 hlYI V I V UI VI 11111 I1dl l li V e S L 19 d l I U 11 IV U.. IVOV f. L/L IOWA CRIMINAL HISTORY DCI 00751797 NON CONVICTION PAGE 1 OF I DATE PRINTED- bCI:00751797 2013/01/20 NAME: DRILLING, BkNJAMXN NASH DOB SEX RAC MGT WGT EYE HAIR SRN POB 19700102 M W 602 175 _ BLU RED IA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 20050604 AGENCY: IA0520200 IOWA CITY Pb CHARGE NO- 01 IA STATUTE IA3210'-2 OWI TRK#: 101551901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / IST OFFENSE COURT CASE ID; 06521 OWCRO72714 CHARGE CLASS: NON CONVICTION TRK4: 101551901 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT APPEAL DATE. DEFERRED JUDGEMENT 20060/20 20060720 PROBATION 365D 20060120 DISCHARGED FROM 20060731 DEFERRED JUDGEMENT. AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS )BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. - DIVISION OF CRIMINAL INVESTIGATION Received Time Jan.26. 2013 9:22AM No -2145 USA IA :nA ' ' _ mssDRILLING BENJAMIN ^:Atilt r - 2142 DAVIS S7 e.n { k IOWA CIT4, w hn 185AD6305 M, 0210712012 Ex° ojj=0a14 ny Q.,..D f7o 3 HAI BLU . B DOB 0110211978x_ n r<reaxanaoens++n6x01140' 3l°l q36 -0(s i