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Home My WebLink About14-167 Authorization Number /9— 1 /_o'7 1 (Office Use Only) 4:41 42/Cilka. APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (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 r— Middle Last 1. Name Thomas � ;tl) 2. Mailing Address 31 A t,)eI)inq fof1 3. Telephone: Home 35 ( .��U� Other: 4. Prior experience in transportation of passengers: /2 4" y///v tAyr 1/,0;f5 7 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /1/2 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? no Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? it/ /fd/r./ Type of offense Where When Ire//) f .ety 7/21/, 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? //2 Type of offense Where When no 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) n C1 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) clerWtaxidrivbadg 03/2014 4 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 555 )Q( 2� ' . 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 ---- -T 60//77 Date t 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 :=51-'s% -7-• I x\ ; . &. On this 15- day of )1n,... ,,t-- 1.)— P _ 5Z_ Notary Public i and for the Stat of Iowa--- 1,2 •s WENDY 8.MAYER , ' Commission Numoer 729428 • '+i'• My Com Sion 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). Signat,us e of Po o1 hief or designee Date l f• 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. / ? Ge_rrirz/ K - i� - F-/5- /`/ Signa'tare of City Clerk or designee Date 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 0LyJu1. 31. .2014 4:25PM Div of Criminal Investigation- • Dcr ro1r,No. 6160 P. 1/2'003 - . . • . , . . . • . e....!) • • STATE Oil IOWA • ,,:;.:.,' 3:,•. - Criminal History Record Check • ', awl' ;;:-' Request Form , • JCI Account Number: L13t r Et- (lespprk.ue) To) Iowa DivhlcaorCrimladluv tigaHon Prorol Yrkanr5 Tikl . Support Operations Bureau,in floor � ,5 4-1_�vr,Ks 9r. 215 L'Pk Sheet _ ries Moises,lows 503t9 110 1 (51-95-7117 (515)7254080 Fir (31a) 33?-'�W- Pboae: • • Fee:. . (31 ii). 5.514)11 I am requesting an Iowa Criminal HistorxRecerd Check oni - - •• twat Phone(fences 3 El at Nan rmao) Middle Name(recomhn tcn Date of Birth(omdatoty) ` Gender (mendamry) ' Social Security Number teoommeedoa) 8Ia? 1 ?.g ' " ' '-' dMale ' ❑Female- . . . .... Watverinformation:Without a Signed waiver from the eobJect orthe request,a complete criminal binary record may not be releasable,per Code of lows,Chapter 692,2.For said*crimbst history record iptormstkn,u allowed by law,always obtain a waver sliptture tram the subject or the request. Waiver&MUM;I herebygivecennimicut for LS stove bumming official ss conduct snlows caninebinoryremome°beckwishdiePittstonofcrbnbul fnvea(pdon(DCI).Any album!'hinery de eanceminr ma that i "'Ey 04n may In relwaed is stifled by law. .. ..,_..__._,�_..m_..-1tf'dtv��si�frarrrl�d;—• -- ,ori - i-�---___..__.�...�._..,�,....__._r__...__.____......-�.,---- • Iowa Criminal Rfstory Record Check Results Pa ma WO As of —1-'31-111 ,a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI EX Iowa Criminal History Record attached,ACI H 53553 Da Initials .ht-A-) . (1? • , ii ba-u7(osasno) "' Received Time J01. 30. 2014 12: 00PM No. 5915 —Jul. 31. 2014 4:25PM Div of Criminal Investigation No. 6160 P. 2/2 IOWA CRIMINAL HISTORY DCI 00535831 COURT DISPOSITION PENDING PAGE 1 OF 1 STATUS UNKNOWN DATE PRINTED- 2014/07/31 DCI:00535831 NAME: ROLING07ESSE THOMAS DOB SEX RAC HGT WGT EYE HAIR SRN FOB 19700827 M W 600 170 BLU BRO MED IA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 19961015 AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 02 IA STATUTE LA713-68 -4-ATTEMPT BURGLARY 3RD DEGREE TRK#: 018665102 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA713-6B ATTEMPT BURGLARY/3RD DEGREE TRK#: 018665102 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19970122 PROBATION lY 19970122 COMMUNITY SERVICE 50H 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: XA052016J JOHNSON CO DIST COURT COUNT NO- 01 TA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCR063448 CHARGE CLASS: NON CONVICTION TRK#: 100675201 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20030214 • PROBATION lY 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 bol. 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 b\13 ,}� irIowa Department of Transportation � Office or Elmer Serw ces {Toll Free)WO-532.1121 it PO Box 0204,Des Moines,IA WU305-00204 515-244-5124 tillilli FAX 515=239-1837 Certified Abstract of Driving Record Inquiry Date: 8/13/2014 DL/ID#: 555XX2267(IA) Customer#: 3352448 Name: Roling,Jesse Class: D ID Status: None Thomas Address: 3162 WELLINGTON Audit#: 7251909 DL Status: VAL DR Issue Date: 08/16/2013 CDL Status: None City/State: IOWA CITY,IA Expiration Date: 08/27/2018 CDL Cert Status: None 522402865 Endorsements: 3 CDL Med Status: None Mailing Address: 3162 WELLINGTON Restrictions: Corrective Lenses Restriction None DR Supplement: Date of Birth: 8/27/1978 Mailing IOWA CITY,IA Sex: NI City/State: 522402865 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 08/25/2013 08/27/2013 592 Speed Johnson IA Name:Roling,Jesse Thomas DL/ID:555)0(2267 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: � Tail\4 8/13/2014 ....,..... y�llr fi IOWA : Gtr; :Yx .,,th . ,. s. hy,BRA I1? ,..„9.4r Office of Driver Services Iowa Department of Transporation Name:Roling,Jesse Thomas DL/ID:555XX2267