HomeMy WebLinkAbout18-053IDENTIFICATION NO.
r L (Office Use nly)
Q��®riC1
APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday)
CITY OF IOWA CITY
410 East Washington Street Failure to complete the "required" information will result in denial of the application
Iowa City. Iowa 52240-1826
(319)356-5040
(319) 356-5497 FAX J-0/1
�'-- //�� First Middle
1. Name(REQUIRED) U(77A !! Ir/r7-/- in/
2. Address (REQUIRED) 167 liu7 �i.�8o-ti S%
3. Contact Information (REQUIRED) Email Cell Phone:,SG3-S�-'��337Cij
(All written c6m-ifiunication sent via email)
4a. Drivers License expiration date (REQUIRED) 0-5 - /7 "e20Z z
b. Taxicab Business Name (REQUIRED) (I f IIBL✓ !'Aii
5. Prior experience in transportation of ps
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere?,N d
Type of offense
What happened to the charge? (Circle one)
Where
When
N
Convicted Dismissed Deferred Suspended Plead Guilty Other
7. Have you been arrested / charged With any traffic offenses in the last five years?
Type of offense
What happened to the charge? (Circle one)
Where
nJ D
When
r
a�
Convicted Dismissed Deferred Suspended Plead Guilty Other
8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? A 6
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)
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
04/2018
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
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).
I herebv certifv 14a) I have issued to me by the Iowa Department of Transportation a valid Driver's license number
issued on 1-/02 lJ expiring on I understand that if I
falsely answer any questions .tis application, that this application may 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, I further agree that, if authorization to be a taxicab driver is granted, to comply at all
times with all of the provisian� rtr�W _0�1 -f 'he City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant y f`f�_ Date) /Y'/
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and swg2n to before me by ToIA-4 A. on thisl�� _ day of
AA^. . -P�%
Public ikland for the State/§f Iowa
I'IAR1-r-iC 1 o '`
I have reviewed this application, DCI report, and the State certified driving record of this applic j�d hue det=ned'that
there is no information which would indicate that the issuance would be detrimental to the safetpyfZe�lthcm welt re of resi-
dents of the City of Iowa City (Title 5, Chapter 2, City Code). Gr
m
Expiration date of Driver's license D 3 /9. 262*
YAA � S O S •!4f • ws
Signature df Folice Chief qQnLgnee 3 Date
AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO
MORE THAN ONE YEAR FROM THE DATE LISTED BELOW.
I
gny Lure of City Clerk r designee
s -i�-ice
Date
###m»m»m»m»#»#»mm#»###»######mm»#»»»#m#»##»##m##»##»##»#»###»##»»x##m»##»###m»»##m###m»m
Office Use Only
Approved application
DCI report
State certified driving record
Website update
Clerk,TMIDRN MMEAPPL92018a.nde .DOC 04/2018
O./IVIILVMay. 7. 2018, V 8:29AM�CabDiv of Criminal Investigation
Iw 1Z19n
lFAQ318936 &/ 013 7 P. r. 1121002
STATE OF IOWA
Criminal History Record Check
' Request Form
To: Iowa Division of Criminal Investigation
Support Operations Bureau, 131 Floor
215 E. 1' Street
Des Mo'Ines, lows $0319
(315) 725-6066
(515)925-6080 Fax
DCI Acoount Number; 9967-F
(if applicable)
From: Yellow Cab of Iowa City
P.O. Box 428
Iowa City, IA. 92244
(319) 338-9777
Phone:
Far: (319) 339-7302
v� /CI -t 6g LdMale ❑Female �. ..
Waiver Yr{farMatlan. Without a signed waiver from the subject of the regpest, a complgte criminal history record may not
be releasablo, per Code of Iowa, Chapter 692.2. For complete criminal history record Ittformatloa, as allowed by law, always
oblain a waiver rinn athM fen,...6-.,.A r...I _..1__ _-----.
Waiver Release; I hcmby live permission for the above rotivesting otnolal to oonduot an Iowa crlminai btstory record check with the Division of Criminpi
Investigation (DCI). My criminal history data eonamin at maintain by the DCI may be re)essed at allowed bylaw.
Waiver Signature:
Yowa Criminal History Record Check Results Y=l
M—< (D61�ac only)
— 1.
As of g s search of the provided name and date of birth reveak
rt a M
I[� No Iowa Criminal History Record found with ICI
tr
Ii
Iowa Criminal kistory-I ecoyd attaohed, DCI 0
DCI initials _
DCI -77 (08/25110)
Received Time May. 4, 2018 12:49PM No -8388 —
C410WA
DOT "imiowadot. u
S18,RTER I SINWER I CUSTOMER DRIVEN.. �....,.,
Driver & IdenlrGcation Services
M fy;X COX -;1 Des train-. IA 603ffrMJ
lonme. 059-711-37241 FM 515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 5/4/2018 DL/ID #: 765A16658 (IA) Customer #: 5781454
Name: Freedain, John Allen Class: C ID Status: None
JR
Address: 107 HUTCHINSON Audit #: 2461623 DL Status: VAL
ST
Issue Date: 01/12/2018 CDL Status: None
City/State: HARPER IA Expiration Date: 03/19/2024 CDL Cert Status: None
52231803
Endorsements: Motorcycle CDL Med Status: None
Mailing Address: 107 HUTCHINSON Restrictions: NONE Restriction None
ST Supplement:
Date of Birth: 03/19/1968
Mailing HARPER, IA Sex: M
City/State: 522318703
History Information
CLEAR DRIVING RECORD
Name: Freedaln, John Allen JR DL/ID: 765A]6658 C
m
o� a
Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Depa"--ejA of TfanspoR'd qn,
do hereby certify that 1 am the custodian of the records held by Driver &Identification Services, that thJs trust Ond ac urate
copy of an official record currently in the custody of said Office, and that I have been authorized by t pI cto�pf theM
Department of Transportation to so certify. rn =
"
6D —_0 tp
In witness whereof, I have roused my signature and the seal of the Department to be set upon this document, at AiVeny, Iowa
this date:
Name: Freedain, John Allen JR DL/ID: 765AJ6658
5/4/2018
Driver & Identification Services
Iowa Department of Transporation