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Home My WebLink About13-006� r CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX Authorization Number 11-(0 (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 1. Name � cnR 2. Mailing Address 3. Telephone: Home Other: 4. Prior experience in transportation of passengers: �1ya4;i %Z 2a L,Y /'// 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? al) 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? ()a Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? '1 E T Type of offense Where When tl(q/J 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Tvoe 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) clerk idnW dg 09/2012 I hereby Seltify that y� jssugd to me by the Iowa Department of Transportation a valid Chauffeurs license number �7 ��jj dd (� . 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 1HliRHRHH11f##4H#4HYYYHHHt*YHR*H*YRH#*fR*iRRt#Hf fRHftfR4itfHR#iRf44tf 11fffHRHHIt1`3fHfffifllffflfflfflfllH!#f#f H##YH#Y#Y##* STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ,-!Z;-c- ZP1 nq . On this day of iif#Ht4#44H43#44#44#44**###*#!1k#**#*H****tkk##**H#H#tHtii#*##*34#*##434H3#H44H*tkf#3f i#*4H#33f#it#34f4f #44H44ii44!!!!4!!*#*HRH#**k 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). Signature o olive Chief 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. k . k(� 1-1'e- � Sign a of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update d.h .idnW.dW.pp2010.d 09/2012 Dec. 18. 2012) _9_03AM Div of Criminal Investigation a DCI 10it:No.8871 P. 1/2 _.. .. - .-STATE OF-IOR'.A- -- Criminal History Record Check Request Form DCI Account Number: �3g3—FL -7— (ifgpliubtol To: laws Division ofCrtminsTlnvertfd■tlou Frotm Manes 1 aXl Support Operations Huralo, l" Floor 5� O 215E 7u Street tVt'"S r. loon Molnn,Iotaa 50319 (515)7256066 Oljw Af sa390 (315) 7254010 Pn • Fbepe: ,i3►4 338- aqy• Fax; .7 319 551' i9 T s .wttnn .n }mvn 6lminnl trbenru awnw.d Phw t- nn•• ImtName meds. 1 First Name t o 1 MlddleName As of 1� a search oftho provided name and date of birth rovealed: Date of Birth (m.&uyj Gender Soolal &-entity Number L 0 7 /''79 tlJMale OFemale O l — 71- 05? l Walv& irtjormatiom Without A signed waiver c om the eub)eet alike request, a complete criminal history record msy not be rele■rable, per Codsof lawn, Chapter 192.2. For Complete criminal history retold Information, at allowed by law, always obtain a walvers .taro b ect alike rcguesL Waiver Release: t holy alve pemLdon lot do sbors tatuaane *MCC tbmW,%dm loft m7nk■t aipoe• Maid CStek wtq de pirtdm ofCr6" fevnniyt(ontOCO.Mr IduaydmcauenMrermn_uiws�ni�Ql7meDClmkYbem�rNlsw. Waiver Signature.. lUVrti rtmrurr ilktfe ae • 1 \.nw%;A leOausae (iter meonty) As of 1� a search oftho provided name and date of birth rovealed: ❑ No Iowa Criminal History Record found with DCI ✓�f Iowa Criminal History Resold attached, DCI M� DCI Initials •-"� ^ -c" N Received Time Dec, 12, 2012 1:19PM No. 7832 Dec.18. 2012 9:03AM Div of Criminal Investigation 20030214 PROBATION IY 20030214 COMMUNITY SERVICE 25H 20030214 DISCHARGED FROM 20030915 IOWA CRIMINAL HISTORY DCI 00535831 COURT DISPOSITION PENDING PAGE 1 OF 1 STATUS UNKNOWN DATE PRINTED - 2012/12/18 DCI:00535831 NAME: ROLING,JESSE THOMAS DOB SEK RAC MGT WGT EYE HAIR SKN FOB 19780827 M W 600 170 BLU BRO M£D IA ADDITIONAL IDENTIFIERS CCH RECORD •*- 01 ARRESTED 19961015 AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 02 IA STATUTE IA713-6B -4-ATTEMPT BURGLARY 3RD DEGREE TRK#: 018665102 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA713-68 ATTEMPT BURGLARY/3RD DEGREE TRK#: 018665102 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19970122 PROBATION lY 19970122 COMMUNITY SERVICE SOH 19970122 02 ARRESTED 20020930 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401-5 POSSESS CONTROLLED SUBSTANCE/SCHEDULE I TRK#: 100675201 COURT DISPOSITION AGENCY: IA052025J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCRO63440 CHARGE CLASS: NON CONVICTION TRK#: 100675201 SENTENCE DISP EPF DAT DEFERRED JUDGEMENT 20030214 PROBATION IY 20030214 COMMUNITY SERVICE 25H 20030214 DISCHARGED FROM 20030915 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 No.8871 P. 2/2 C Iowa Department of Transportation Office of Driver Services (Toll Free) 800332-1121 PO 13=92041, Des Moines, [A 50305-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/10/2013 DL/ID if: 555XX2267 (IA) Customer if: 3352448 Name: Roling, Jesse Thomas Class: D ID Status: None Address: 3162 Wellington or Audit #: 3827929 DL Status: VAL Issue Date: 10/29/2009 CDL Status: None City/State: Iowa City, IA 52240 Expiration 08/27/2013 CDL Cert None Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 3162 Wellington or Restrictions: Corrective Lenses Restriction None Date of Birth: 8/27/1978 Supplement: Mailing City/State: Iowa City, IA 52240 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 01/31/2008 02/28/2008 Speed (10 mph & under In 35-55 mph zone) 92 IA Name: Roling, Jesse Thomas DL/ID: 555XX2267 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: >.......• ;.4i'', 1/10/2013 p IOWA ' z''; -f D. 0. T.:� i F Office Driver Services ��e S of '��a"�.��-� Iowa Department of Transportation Name: Roling, Jesse Thomas DL/ID: 555XX2267