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Home My WebLink About13-021CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319)3S6-SO40 (319) 356-5497 FAX 1. Name 2. Mailing Authorization Number '13— P_' (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 3. Telephone: Home /%6 c� Oth r. 4. Prior experience in transportation of passengers: ,L { U 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? / Type of offense Where When 6. Have you bq�n convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? To Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 4 Type of offense Where When 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? Alld 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) clerMl dnWady 09/2012 I hereby certify tha I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number �.3 I C C- 1'� . 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 a d documents relating to this application, and I further agree that, if a license is granted, to comply at all ' as with all of the r isions 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 ) and sworn to before me by JA(tES 10z"FR- On this day of 'Ate i.tR'i`m SONDRAEFORT !— My 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). Signal;,/" ignatu of Poli a hief 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. Signature of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. a-� -13 Date #*##**#*##***RRMM##R#MRM##R##RRRYR#Y#R######################################################*#*###*#################*#***********RR**R*****RRM** Office Use Only Approved application DCI report State certified driving record Website update wenn drmbadgeapp2010.d 09/2012 Iowa Department of Transportation Office of Driver Services {Toil Free) 800-532-1121 5'O Box 9204, Des Moines, 1A 5030E-9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: 1/24/2013 Name: Miller, James Richard Address: 0223 Garfield Avenue City/State: Mechanicsville, IA 52306 Mailing Address: 0223 Garfield Avenue Mailing City/State: Mechanicsville, IA 52306 Name: Miller, James Richard DL/ID: 239CC4258 Certified Abstract of Driving Record DL/ID #: 239CC4258 (IA) Customer #: 1130919 Class: D. ID Status: None Audit #: 5720909 DL Status: VAL Issue Date: 01/04/2012 CDL Status: None Expiration Date: 01/17/2014 CDL Cert Status: None Endorsements: 1L CDL Med Status: None Restrictions: Corrective Lenses, Left and Restriction None Right Outside Mirrors Supplement: Date of Birth: 1/17/1931 Sex: M History Information CLEAR DRIVING RECORD Pursuant to Iowa Code 8321.10, 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 +"""•:�y/j �y 1/24/2013 IOWA �: Q�� D. O.T.% 9f Office of Driver Services UBNEA. .��I - Iowa Department of Transportation Name: Miller, James Richard DL/ID: 239CC4258 J rL� U. 019 9 , O STATE OF IOWA Criminal History Record Check Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 E. 7th Street Des Moines, Iowa 50319 (515)725-6066 (515)725-6080 Fax I am reeuestine an Iowa Criminal Mstory Record Check on: DCI Account Number: 9861-F. (dapplicable) From: City Clerk's Office City of Cedar Rapids 101 First Street SE Cedar Rapids, IA 52401 Phone: 319-286-5060 Fax:. 319-286-5130 Last Name (mandatory). First Name (mandatory) MiddleNam (mandatory) Date of Birthandamry) Gender (mandatory) Social Sciuritffmnber (mandstory) ;7 Male ❑Female Waiver Information: 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 comlilete criminal history record information, as allowed by law, always obtain a waiver si ature from the subject of the request W7iVel Release: I amby give pc®ission for the'above requesting oliicialto conduct on Iowa criminal history record check with the Division of Criminal . .Investigation (DCI). Any criminal history data n emiag me that' m ' tained by the D be I ed m allowed by law. ' ' Waiver arLgiLQtllle' Date . Iowa Criminal History Record Check Results (DCluse only) . As of a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI ❑ Iowa Crjminal'History Record attached, DCI # DCI -77 (08/25/10) DCI initials Page 1 of 1 Single Contact License & Background Check g g Results Criminal History Background Check Last Name Other Last First Name DOB SSN Name Selection Criteria Miller James 1931 -January -17 480441943 Results Further research is required. Please await DCI's final response for criminal history. Please note: There may be multiple individuals with similar search criteria, requiring more research. Background Check Complete As Of 1/24/2013 11:22:06 AM NOTE: The first and last names, date of birth, and SSN displayed in the abuse registry and criminal history results are just as they were entered on the screen. Billing Account 9861-F Cash Deposit Currently at $1334.00 Generate PDF Search Again https://www.iowaonline.state.ia.us/SING/SINGSQLProcess.aspx 1/24/2013 ■e9■ �r Submiued 2013.01-24 11:22:06.493 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) REQUEST (* indicates a required field) I am requesting an IOWA CRIMINAL HISTORY record check on - (DCI use only) Page 1 of 1 ACCOUNT NUMBER; 9861-F CITY CLERIC - 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 MILLER JAMES RICHARD Last name* First name* Middle name NO Maiden/Other Last name Volunteer =7/1931 480441943 Date of Birth* Gender* Social Security number* RESULTS As of 1/29/2013 10:11:42 AM, a name and date of birth check revealed; CCH Record Attached DCI # No CCH Record Found X DCT initials Waiver on Ftile_ _ 1 hereby give permission tot the above requesting official to conduct an Iowa criminal history record check with the Division of Criminal Investigation. Any information maintained by the DC1 may be released as allowed by law. Received Time Jan. 29. 2013 11:35AM No. 2161