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Home My WebLink About14-187 Authorization Number / t— (Office Use Only) CITY OF IOWA CITY APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made 410 East Washington Street between 8 a.m.to 3 p.m., Monday—Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX � First Mld,e Last 1. Name %1/ 'E o N ThAidOcK 2. Mailing Address ?15 6/0om'O9 St %u e,-4/ 3. Telephone: Home 44,1g-e/ Other: 317. 3 a 5. 3-;)-`19' 4. Prior experience in transportation of passengers: 50 y 9A5 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? / /C7 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? /✓' . Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /VG, Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? NO 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) NS' 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerkflaxidrivbadg 03/2014 Jet \...,,, I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number ---7--`-'—' 7. % A / ' e i ci `f . 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) !-., //JJ "q Signature of ApplicantJz z `T� �,�1/z;Zy Date �/ d 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. STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ---)-0, f 5 )T . K„t o pi c 1( . On this a 1 day of /A L U S- ,-o/L4 �alAr tnfFNnY S MAYFR otary Public inland for the State of I��a i iCommission Number 729428 i • My Comm ssion Expires 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). 7/i Signatu - :�Pe - Chief or designee Date Y06-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. li "4..x.__..er-44..., .7) . -ke-,i,,,,t,../ , 7/,7 11/ Signature of City Clerk or designee ate Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 5 1/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerWtaxidrivbadgeapp2014.doc 03/2014 • ._ . , ,...____ __ i r4eitiviimpithiiUtDOT * . . . . www,iowadot gv SMARTER I SIMPLER I CUSTOMER DRIVEN° Driver —. Office of Driver Services PO Box 9204.1 Des Moines,IA 56366-9264 Phone:515-244=9124 1800-532-1121 I Fax:515-239-1837 1837 Certified Abstract of Driving Record DL/ID a: 721YYB794(IA) Customer Si 1678355 Inquiry Date: Knopick,) .ID Status: None Name: E James John Class:AuditA DL Status: VAL Address: 815 E BLOOMINGTON ST Issue Date:S743890116/2CDL Status: VAL Issue 10/16/2013 CDL Cert Status: Excepted Intrastate City/State: IOWA CITY,IA 522452605 Expiration Date: 11/04/2015 CDL Med Status: None Endorsements: N Restriction None Mailing Address: 815 E BLOOMINGTON ST Restrictions: NONE Supplement: Date of Birth: 11/4/1939 Mailing City/State: IOWA CITY,IA 522452605 Sex: M History Information CLEAR DRIVING RECORD • Name:Knopick,James John DL/ID:721YY8794 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 torec authorizeddsDirector eld bye hOfice offtDrir Iowa Services, vpartthat mhat thisrlis a true and accurate urate copy of an official record currently In the custody of said office,and that I have t o tify. 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: Ie.'.......• .. % 8/19/2014 i73%..glIi8 OBNRice of Driver Services 1u,„,„,,,,„_-- IowaDepartment of Transportation Name:Knopick,James John DL/ID:721YY8794 --)Aug. 26. 20142 9:52AM Div of Criminal Investigation -, "DCI Iov.No. 8002 P._1/1 • er1 np �.� STATE OF IOWA /r -1\ Criminal History Record Check (``!� Request Form DCI Account Number. 4383.-FC . (lreppllcable) Tot Iowa Division of Criminal Investigation Frans; Marco's Tani Support Operations Bureau, In Floor 215 E.7h Street 116 Stevens Dr. Des Moines,Iowa 30319 (515)725-6066 Town City,Ia 52240 (515)123-6080 Eax Phone: (319)337-8294 Fax: (319)3518294 I am requesting an Iowa Criminal History Record Check on: Last Name (mmdalery) First Name(mandatory) Middle Name(recommended) • 6-5,/od'io-k • Ames JohJ • Date of Birth(mandatory) Gender(memory) Social Security Number(recommended) 4 ®Male ❑Female 172.5D.- as Waiver Irfarmatmn:Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of lows,Chapter 692.2.For complete criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request. Waiver Release:r hereby give permission for the slava rtquaeting official to cowluct an Ion criminal btstmmeerd cheek with the Division of Criminal Invwligatlon(DCQ. Any criminal Idatory data concerning tee that is maintained by the DCI maybe releared as allowed by law. Waiver Signature t� xtl!sin l k - S'-'?'121 ,Iowa Criminal History Record Check Results (Del a�anib O As of_ ' 1 ,a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCI ; •, 0 Iowa Criminal History Record attached,DCI# . • • • DCI initials DCI-17(081251 l0) Received Time Aug. 20. 2014 9;42AM No. 2035