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Home My WebLink About14-093 Authorization Number / `'( — 6/3 - 1 (Office Use Only) moi..®�' 47::11144riliatt Aft 1113 MEW 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 3O 1\3 Middle Last 1. Name �j! (� I 2. Mailing Address 23(1 ( E rocks I CXe }fir 3. Telephone: Home CtG") S-`"1 - S3ti S Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /v 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? 1\J Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 'v 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) U 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 I hereby ceA0 that I h l issued to me by the Iowa Department of Transportation a valid Chauffeur's license number X1-3 . 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) fr Signature of Applicant Date r 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. ************************************************* *****************************************,.***** *_***************.,*,.*t.,,..4,*********,.******* STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by >> 0.(1_ ►,x n N t_. _ ( ( . On this 6--6 day of Apr‘ - ) 9 WENDY S MAYER _ . L . . ;44." Number 729428 Notary PubliAn and or the Sta e of low`a My CO)tp.3334511 furoc 3-1 La 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). (-1//t5/-/ Signatur ofChief or designee Date �J 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. "e?//5: //4 Sign ure of City Clerk or designee ate Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (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 C u vwvw tOwadOt. ov SMARTER [ SIMPLER I CUSTOMER DRIVEN O ,... .. Office of Driver Services PO Box 92041 Des Moines,A 50306-9204 Phone:515-244-9124 1300-532-1121 I Fax:515-239-1337 vow/iowadot.gov Certified Abstract of Driving Record Inquiry Date: 3/7/2014 DL/ID Si: 803225155(IA) Customer St: 5077611 Name: Barclay,Jonathan Rost Class: C ID Status: VAL Address: 201 5 5TH ST APT 304 Audit S: 6728476 DL Status: VAL Issue Date: 02/27/2013 CDL Status: None City/State: AMES,IA 500103117 Expiation Date: 02/06/2018 CDL Cert Status: None Endorsements: NONE CDL Med Status: None Mailing Address: 201 5 5171ST APT 304 Restrictions: NONE Restriction None Date of Birth: 2/6/1985 Supplement: Mailing City/State: AMES,IA 500103117 Sex: M History Information CLEAR DRIVING RECORD Name:Barclay,Jonathan Rost DL/ID:803225155 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: ;Q./.-• "6 p I, 3/7/2014 3oe IOWA ':¢, �. •z: Apr. 3. 2014 3: 37Pg Div of Criminal Investigation ,No. 6619P. 5/5 Final. di. eon Ji win eIly t•I ela bI ly UI tuna uI LY VU, 7'J UU I . L/ L !c A P.1.1..ii V" Criminal History Record Check ;_' • ivAl,•• • D CI Account Number: Lf op3-1= ' (iCeppliceblc) To: Iowa Division of Criminal Investigation From: City of Iowa City Support Operations Bureatl,1't Floor City Clerk's Office 215E.7th Street 410 E.Washington Street Des Moines,Iowa 50319 (515)725.6066 Iowa City, IA 52240 (515)725-6000 Fax • • • Phone: 319-356-5041 Fax: 319-356.5497 ' I am requesting an Iowa Criminal History Record Check on: . Last Name(mandatory) First Name(mandatory)) Middle Name(reconN,ended) eccdow 5apa a • Date ofThrth(mandaatory) _Gender(mandatory) Social Security Number(rrcommendrd) Zb - . ' ITgSYlale (]Female 'it{- ) / '7003 Waiver Information;Withouta signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code ofIowa,Chapter 692.2, 'or complete criminal history record Information,as allowed by law,always obtain a waiver signature from the subject of the request. Waiver Release:Therebygive permission forihoabove r um • official to conduct an Iowa criminal 1dstory record che etc with the Division oftriminal Trwsslfgation(DCl). Any criminal history dalaeoneoming - tat Is mai rained by Ihel)- >.released as allowed by law. Ie . t\ WaiverSignatare; r I // ( �1 Iowa Criminal History Record Check Results _'.' tuchisFOnly) ' w 'ti b. a search of the provided name and date of birth revealed: =1 C; ;,J CD L7:•'' v 0%-71 ph No Iowa Criminal History Record found with DCT u = r a N . 0 Iowa Criminal History Record attached,DCI it . DCT initials nct.a7 nvictim ' Received Time Mar, 31. 2014 3: 15PM No. 6351