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Home My WebLink About18-058 e IDENTIFICATION NO.1E5 — _ (Office Use Only) 4.1p6in eta, %WM Oki;akallr 116 amenuAr 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 First Middle Last 1. Name(REQUIRED) tYt "'l - /e/61.1,:eik L`.R 2. Address (REQUIRED) a 6 t ituAv..ke t'4 (?/n 1 T 5 ?44- 3. 3. Contact Information(REQUIRED) Email: iV 5 e4e. r.r /C ,� /79.5,7. Corn Cell Phone: g//'-y`y/-02/ (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 77/7/x,u;a b.Taxicab Business Name(REQUIRED) Ye 244 fwd CIT7 5. Prior experience in transportation of passengers: 6. Have yeu ever been arrested I charged with any misdemeanors and/or felonies in this State or elsewhere? h 0 Type of offense Where When t] m C7-< I- �n rn rn n• ar r V What happened to the charge?(Circle one) cn Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested/charged with any traffic offenses in the last five years? y C s Typeh [ of offense Where When ^ e-'.•7 5-pef Loee(l.! /[.�, y/J/Zc t 'y Se L i/ &l� 610/4/v/aL,„ What happened to the charge?(Circle one) onvicte Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? n J 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) �?D (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 hereby certify that I have issued to me by the Iowa Department of Transportation . valid Egver's license number 0%,2 a I' T) 5''/7 issued on G/7/2(.:,; expiring on / Zvi -7::I undej and that if I falsely answer any questions in this application, that this application may be denied. I agree-fhetjn rrphing thi4Application, I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to exacnifie a and V.ecords and documents relating to this application, and I further agree that, if authorization to be a taxicab d* s grented, do comply at all times with all of the provisions sooff�Title 5, Chapter 2, of the City Code. (Needs to be signed in fret ggf a�lotaryi lic) •Signature of A licant "4. Cc �-h /�/ f -� 9 PP Date % � .)1-31 4 L .yw ui ***+# ******+***********+**********+*****#***###***#****##***AAA. _k*+***************************#*+i*#*****#****+**+++*****+*** STATE OF IOWA ) COUNTY OF JOHNSON ) I,, ubscribed and swrn to before me by til i( oe! & y t-&i r-I on this '7t' 1 day of CHRISTINE OLNEY _ 1 Commission Number 806232 'otary Public in and for th ate of Iowa * •autit * My CammissIbn rest. CI_�� _- ****************************#**********AAAAA**A###*#***********##**************##+*##***************+**#*A AAA AA******#*********#**************** I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City(Title 5, Chapter 2, City Code). SS Expir tion date of Driver's license 06./6 • 2°2.6 ../64.4_, D .• 0-7. 3-qi B --: • • _• .-- - = ,r designee 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. _ C.0 k �� --- l t -/ Sign ture of City Cler/' r designee /f� Date Office Use Only Approved application DCI report State certified driving record Website update ae�TAXIDRIVBADGEAPPL92O18amended Doc 04/2018 "_....." SMARTER I SIMPLERCUSTOMERDRIVEN mi .iowadot.gov Driver&Identification Services PO Box 9204 I Des Mines,IA 543C6-9204 Ptx ne 5 -244-9124 1 Fax 515-2394837 Certified Abstract of Driving Record Inquiry Date: 5/24/2018 DL/ID#: 228AD8474 (IA) Customer#: 687190 Name: Earles, Michael Allan Class: A ID Status: No Address: 32 GLEASON DR Audit#: 7084993 DL Status: VALoe Issue Date: 06/29/2013 CDL Status: C-ELG G woos' City/State: IOWA CITY, IA Expiration Date: 06/16/2018 CDL Cert Statue"—Pion-Ejsceptede�'� 522405838 �bter5l to t Endorsements: NONE CDL Med Status r)t Certified in Mailing Address: 32 GLEASON DR Restrictions: Corrective Lenses Restriction 7,4cidhe O Supplement: .--- Date —Date of Birth: 06/16/1956 O o Mailing IOWA CITY, IA Sex: M y' cP City/State: 522405838 CDL Medical Examiner's Certificate Certificate Specifics Explanations Medical Examiner First Name Jeremy Medical Examiner Middle Name Lewis Medical Examiner Last Name Nelson Medical Examiner License Number 002023 Medical Examiner National Registry Number 7661525813 Medical Examiner Jurisdiction IA Medical Examiner Phone (319) 358-5736 Medical Examiner Type Physician Assistant Medical Certificate Issued Date 11/16/2015 Medical Certificate Expiration Date 11/16/2017 Date Added to CDLIS Driving Record 111/17/2015 CDL Downgrades Effective End Issuing JUR 01/15/2018 IA History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 03/08/2017 04/03/2017 593 Speed Johnson IA 04/08/2017 05/03/2017 F04 Seat Belt Violation Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 03/08/2017 972671 IA Name: Earles, Michael Allan DL/ID: 228AD8474 Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver&Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by Driver&Identification 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: NT i'! > 5/24/2018 da 511;i t �ic. Driver&Identification Services L Dpi. Iowa Department of Transporation Name: Earles, Michael Allan DL/ID: 228AD8474 CJ m =IC) <fA� rFrirn i . . 5, C, CJ1 Jay. 30. 20184. 2: 29PM�CabDiv of Criminal Investigation (fAx)319339,°u2817 P. r��31003 • /1 S:: rr ' ;, STA.TEOff' IOWA .: ';" . . r`� `k,t, Cri i History .,.. .- +rRe . 14,!,p1b,�";,. m naRecord Check . �;.:, : ,; � � {r;;::. 1; i, ° Request Forms•,,–"1.,;4-,.!:`,,,-,•,,.;:,„ ,, ,1 .11 ,-F• 'i�1:.r6../�,� DCI Account Number: 9967-F (if applicable) To; Iowa Division of Criminal Investigation From: Yellow Cab of Iowa_Cite Support Operations I3Ureau, 1”Floor P.O. Box 428 '— 215 E.7"'Street • • Des Moines,Iowa 50319 • Iowa City,IA. 52244 (515)725-6066 (515)726-6080 Fax • (319)338-9777 phone: Fax: (319)339-7302 1am re uestin an Iowa Criminal history Record Check on: _ Last Name mandatory) First Name(mandatory) • Middle Pottle(recommended) • ABLE- / ia/--iAE A`4- ^/ — • _ Date of Birth (n,anda1o,yj Gender(mandato 'Social•Secrbrity Number(teeommendcd) 6/)/.., //941(.„ ,Mage ❑Female '7/8‘,-. 74-070/s-- Waiver 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.Por complete criminal history.record Information,as allowed by law,aiways obtain a waiver sijnature from the sub eta of the ruesti . . ry C7 m • Waiver Release:I hereby glee pcmmtsslon fbr the above requesting official to conduct an Ioeia criminal history record gYpcaith IkOlvislo'rintlnel Investigation(DCI), Any criminal history data concerning mc that is maintained by the Del may be released as arloweel by laws _ i Waiver Signature: ,i _.,i''.- y",::,.. .� r • - - . . - . ' • ox, . tt - Iowa Crim' aZ i for Record Chec1 Results - - �; (DCI use only) As of 5 341 t a search of the provided name and date of birth revealed; ' • 10 1.,..)No Iowa Criminal.T-listory Record found with DCI .l "Ci 0 Iowa Criminal History Record attached, DCI# : . a N DC initials A DCI-77 (08/25110) • Received Time May. 24. 2016 2:08PM No, 9487 • •