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Home My WebLink About14-029 Authorization Number — 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.) Iowalowa 52249-1826 X319) 356-5040,;/`{- (319) 356-5497 FAX First Middle Last 1. Name jJ.2 eV+'l15� ,I�t of\1A 2. Mailing Address 2A 5-g cr IU( 3, Telephone: Home ._51 of q 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? 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? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) 1' 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) cierWtaxidrivbadg 03/2013 I hereby certi t I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license ••.. mber 1 gf- � . 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) �� !4 Signature of Applicant r7ca,tc61,t _ Date aC/ 1 G1 / 7 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ._ L �• On this L/ day of F e-W-1 A r...f v� oz cc l 4 . ��'"1 WENDY S.MAYER Notary Public in d for the State of loQa Commission Number 7Z942b My Commission Expires ******., OWn ,ft.. xAr�ll7E *************F*f******:*tii*!F*:rit**F*Rrri******************************************************************** 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). -v. - , .2//4///47 Signat e of Police Chief• 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. e....-,.---x--) /') . ) .4?....t..-/--"/ ..Z//-'7 Signatur f 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 clerkitaxIdrivbadgeapp2010 doc 03/2013 Feb. 12. 2014 3: 10PM Div of Criminal Investigation No. 2783 P. 1/3 Feb. /, 2014 3: 26VM City Clerk - City or Iowa Cily No. 'fib' r. • • • 10-1 ° STATE OF IOWA Mr,jv t :. Cimm�mall History Record Cheek r F, ,;4i•`? 'i/ - Sk,\ ar � rr, :. te%, ir . ; nnT DCI Account Number: HIDDit —P (If applicable) To: Iowa Division of CriminalInvestigation From: City of Iowa City support Operations tureen,1"Eloor City Clerk's Office 215E,7ih Street 410 E.Washington street Des Moines,Iowa 50319 • (515)728.6066 Iowa City, IA 62240 (5115)725.6080 Fax • Phone: 319-356-5041 Fax: 319-366-5497 • I ain requesting an Iowa Criminal History Record Check on: Last Name (mandatory) First Name(mandatory)'] Noddle Name(recommended) $oDJN1i o A A`SSAxC TEAM 1 ' J ti N/3r `1 ar•Y( \f P-Puvt Date of Birth(modem" Gender(mandatory) Social Security Numb er(rccormneneed) (EN 10 gr Male bFemale M 020 g tr Wciverinfcrnwttott:Without a signed waiver from t)Iti subJect of the request,a complete criminal history record may not be releasable,per Coda of Iowa,Chapter 692.2.Fpr complete criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request, — .— . . Waiver Release:I hereby givo permissionfor the above requesting official to conduct an Towa criminal Idsloty record check with the Division of Criminal Tnyestigellon(DCI). Any aiming'history data concendng me fiat II mainteloed by the DCI merybe released al allowed by law. Waiver Signature: n ai „ � . • Iowa Criminal I tori Record Check Fault (DCI use only) As of ).,11a`l K , a search of the provided name and date of birth revealed: ^r, t/) • F No Iowa Criminal History Record found with DCI rt !``) I ,_ ,T.' .11f7 ...1 C):LI :-017 y M_ t cy) 1 El Iowa Criminal History Record attached,DCT# �';•^ - ��— U r z �( � 2'F Na > _ DCI Initials h1 Received .Iime-F,eb,„•,1..:,2014— 3:24PM—No. 8921 - nIowa Department of Transportation Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Moines,IA 50305-9204 515-244-9124 FAX.515-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/13/2014 DL/ID#: 413AF8068 (IA) Customer#: 5597450 Name: Bodjona, Bassai Jean Class: D ID Status: None Address: 2258 OAKLEAF ST Audit#: 6640514 DL Status: VAL Issue Date: 01/24/2013 CDL Status: None City/State: CORALVILLE, IA Expiration 12/31/2015 CDL Cert None 522411365 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2258 OAKLEAF ST Restrictions: NONE Restriction None Date of Birth: 12/31/1985 Supplement: Mailing City/State: CORALVILLE, IA Sex: M 522411365 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 10/26/2011 11/28/2011 M14 Fall to Obey Traffic Sign/Signal Johnson IA 07/13/2013 08/01/2013 592 Speed Scott IA Accidents -Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 10/31/2011 654402 IA Name: Bodjona, Bassai Jean DL/ID:413AF8068 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: .�y Mil 2/13/2014 Mil IOWA y''� s rya D. O. T. ' 447 dela , 'f A giScf Office Department Servicesv Iowa Transportation Name: Bodjona, Bassai Jean DL/ID: 413AF8068