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Home My WebLink About13-001.�r 1 it"III EccccrA no =QA CITY OF IOWA CITY 410 East Washinglcn Street Iowa City. Iowa 52240-1826 (319) 3S6-5040 (319) 356-5497 FAX 1. Name 2. Mailing Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) i3-/ (Office Use Only) 3. Telephone: Home -1) 1 N - �) 1� :�4 -J 3 (g-? Other: 4. Prior experience in transportation of passengers: 2 \) cc S 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When Vl d 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? YN b Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? S Type of offense Where When L o. 8. Has your drivel's license or chauffeur's license been suspended or revoked in the last five years? Yl 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) V1 0 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW >_4o Z 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) cler axidrivbadg 09/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number �� Y L U \ 4 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. 1 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 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by1 q t s P.k<#2'JA /( On this 3 r� day of FORT � berrv11tl7 tss7at Notary Public in and for the State of Iowa ###i44*##**#**##***##f*fYflY#fflffXXf#RX#*#*****X#**t*#tt*A##*##*ii*f#*lfYtfifflfflltffftffffllifYflf#fflfX#R*fR#R***#***R***##tR#tt#fflYllYff Yf 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). # Signa re of Police CNdf f 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. Sig re 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 ded midis dgeapp2010 doc 09/2012 Iowa Department of Transportation 1 Office of Driver Services (Toll Free) 500-532-1121 PO Box 9204, Des Maines, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 12/12/2012 DL/ID #: 808YY5014 (IA) Name: Kendall, James Ray Class: D Address: 2051 BIRCHWOOD DR Audit #: 4705782 CDL Med NE Issue Date: 09/28/2010 City/State: CEDAR RAPIDS, IA Expiration 12/09/2014 524022813 Date: Endorsements: 3 Mailing Address: 2051 BIRCHWOOD DR Restrictions: NONE NE Date of Birth: 12/9/1944 Mailing City/State: CEDAR RAPIDS, IA Sex: M 524022813 History Information Customer #: 2613054 ID Status: None DL Status: VAL CDL Status: None CDL Cert None Status: CDL Med None Status: Restriction None Supplement: Convictions Citation Date Conviction Date ACD Explanation County JUR 07/26/2009 08/05/2009 S92 Speed 6 IA Name: Kendall, James Ray DL/ID: 808YY5014 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: •:.`i�1yr 'tz' 12/12/2012 IOWA r'...... �QJ Office of Driver Services aRIYEB,; Iowa Department of Transportation Name: Kendall, James Ray DL/ID: 808YY5014 WA 4- STATE OF IOWA Criminal History Record Check Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 E. 71e Street Des Moines, Iowa 50319 (515) 725-6066 (515)725-6080 Fax I am reguestina an Iowa Criminal History Record Check on: o9 9 �� DCI Account Number: 9861 -F - (if applicable) 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) Middle Name (mandatary) Date of Birth (mandatary) Gender (mandatory) Social Secnri Number (mandatory) ' EffQale ❑Female . S n tc, 0 'C('�] Wdiver Information: without a signed waiver from the subject of the request, a complete criminal history record.may not 'be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed by law, always obtain a waiver signature from the subject of the request *diver Release: I hereby give pemdssion for the above requesting official to conduct an Iowa criminal history mcord check with theDivision of Criminal ' Investigation (DCI). Any criminal history data conceming me that is maintained by the DCI may be released as allowed by law. Waiver Signature: 4 Date v 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 Criminal History Record attached, DCI DCI -77 (08/25/10) DCI initials JuNv rage 1 of 1 Q'� Single Contact. License & Background Check Results Criminal History Background Check Last Name Other Last First Name DOB SSN .Name Selection Criteria Kendall James 1944 -December -09 483506097 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 12/12/2012 11:36:02 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 $894.00 Generate PDF Search Agam LLLA https://www.iowaonline.state.ia.us/SING/SINGSQLProcess.aspx 12/12/2012 0 Submitted 2012-12-12 11:36:02.320 IOWA RECORD CHECK REQUEST To: Iowa Division of Criminal Investigation Bureau of Identification 215 E. 7th Street Des Moines, -IA 50319 (515)725-6066 (5 15)725-608 0 (fax) FORM S (* indicates a required field) 7..am regnesting an IOWA CRIMINAL HISTORY record check on: 110. 7V]7 F. I/ I Page i of 1 ACCOUNT N1U1v1BER:9861-F CITY CLERK - CITY OF From: CEDAR RAPIDS 3851 RIM RIDGE DRIVE NE CEDAR RAPIDS, IA 52402 Phone 319-286-5060 Fax 319-286-5130 Contact Preference: F KENDALL J BES RAY Last name* First name" Middle name NO Maiden/Other Last name 'Volunteer 12/9/1944 'M 483506097 Date of Birth* Gender* Social Security number* 0)Cl use only) RESULTS As of 12/18/2012 3:05:14, !H, a name and date of birth check revealed: CCH Record Attached DCI # No CCH Record Found X DCT Initials Waiver on File_ y-gs _ 1 hereby give permission for the above requesting official to conduct an Iowa criminal history record cht with the Division of Criminal Investigation. Any information maintained by the DCT may be released as allowed by law. Received Time Dec. 18.. 2012 3:54PM No. 1956 .—.. n4.ntn