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Home My WebLink About14-079 t Authorization Number t 76.1 1 (Office Use Only) APPLICATION FOR TAXI 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 Fir t Middle -- Last 1 ` 1. Name-7)00-e, '� l�iyv ✓ 11��4rStOi1 2. Mailing Address —35::::0(-35::::0( /U( SUv��C l- 3. Telephone: Home Sl -1 - Y3- �;1 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? "A'),,,a Type of offense Where When kM I " w 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? A l% i 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) 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) derk/taxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number . . 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 I /(/^ Date}/U, U,t 1 01 STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by P -t �,, u' }�p� `,o„` . On this -1- ) day of 4lap_ - c44 . Notary Pu.f1 in and for the: ate of owa iya r+ WEtvat J NMAYER Commisswn Number 729428 �� Mycommission Expires ******** * Y+ ** ***** 4 * t1******* ************************************************************************,c**************************** 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). 11 I _ - ,7,L/J Sign- re of '• ic,Chie or designee Date 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. Signa .re of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/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 clerkltaxidrivbadgeapp2010.doc 03/2013 •fvlar. 27. 2014 11 : 26AM Div of Criminal Investigations No 6116 1P, 2 ;tt, STATE OF IOWA n"� a i ,r%r n ka, Criminal History 3ecod Check • -� �,?-: :,a. t ;, �;,iown � ,' ,7. _ , s , Request Form ' DCI Account Number: Lit 6a— C— O applicable) To: Iowa Division of Criminal Investigation From: City of Iowa City Support Operations Bureau,lac Floor City Clerics Office 2.15 E.7th Street 410 E.Washington Street Des Moines,Iowa 50319 (515)725.6066 Iowa City, IA 52240 , (515)725-6000 Fax • Phoma: 319-356-5041 Fax: 319-356-5497 • I am requesting an Iowa Criminal History Record Check on; • Last Name(manaalory) First Name(mandatory) Middle Name(recommended) (Ai w on --10)D-ein-1- tt, ac1 Dateof Birth(mandatory) Gender(mandatory) Social Security Number(recommended)� Wi '- I D ~ ) 9 53 1:1r(ale Oremnle 3CI ('�:•a 13tJa en Waiver Ifjformal/ali Without a signed waiver front the subject of the reg gest,a complete criminal history record may not be releasable,per Code oflown,Chapter 692,2,For comuiete criminal history record information,as allowed bylaw,always . obtain a waiver signature from the subject of the request. Waiver Release:l herebyglve permission for the above trop:sling omcial to conduct an Iowa criminal hlstory record clicckvith the Division of Criminal Investigation(DCO. Any criminal history data concemingme that is maintained bytheDelmay be relented as allowed by law. /r WatverSignaturei t 0,4 i(/l • Iowa Criminal History Record Check Results (Wimp only) I c.r As of 31X111 ( <.• asearch of the providedname and data of birth revealed; •" C)-7, N c 7i:. No Iowa Criminal History Record found with DCI :0 it, z. —t, ;,n 1_ ® Iowa Criminal History Record attachdam,DCT it '~'- ^r r. DCX initials Pte. Received l meVaArn.r.2014 2: 17PM No. 5869 • SMARTER I SIMPLER I CUSTOMER DRIVEN Wwv�r.iDWaC{Ot ov 9 Office of Driver Services PO Box 9204 Des Moines,(A 50306-9204 Phone:515-244-9124 l 800-532-11211 Fax:515-239-1337 wzrn_iowadot.gov Certified Abstract of Driving Record Inquiry Date: 3/18/2014 DL/SD x: - 651AH6461(IA) Customer#1 6043030 Name: Wlikerson,Robert Earl Class: D ID Status: VAL Address: 3509 SHAMROCK PL Audit 0: 7825938 DL Status: VAL Issue Date: 02/26/2014 CDL Status: None City/State: IOWA CITY,IA 522455137 Expiration Date: 06/10/2019 COL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 3509 SHAMROCK PL Restrictions: NONE Restriction None Date of Birth: 6/10/1983 Supplement: Mailing City/State: IOWA CITY,IA 522455137 Sex: M History Information CLEAR DRIVING RECORD Name:Wilkerson,Robert Earl DL/ID:651AH6461 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 Transocrtatlon to se.certify. I - - - - -- -- —- 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: .. ! E 0jlill t . .. `�✓'0,� 3/18/2014 IOWA 114t Ilk D. 0. 4:92 itaerionezt4 ir.4 /Q� , Office of Driver Services h‘ Iowa Department of Transportation Name:Wilkerson,Robert Earl DL/ID:651AH6461 fi '. • tit