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Home My WebLink About14-007 Authorization Number — I 1 (Office Use Only) EEO igt III % ga MO MIN allr 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 Fi t Middle Last j4 /k S 2. Mailing Address 3,2 0 S-t Q ,j 3. Telephone: Home Other: 3 1 l ( 4-7 I - 73 T3- 4. Prior experience in transportation of passengers: 5 y V S t o -. - C v t✓i 4, -100(1 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When IPoSS . of C4--314✓&PP/' ib r.V+L 0200 6. Have you beprkconvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 'V U Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? t�S Type of offense Where When (5) 3 y7/10 i/r1'e.S(.51A a co. s('z.Gf ) 10 vv1 fo k CAA cLP4 vt 3 S 5 S.nvzt f' 2D4€ 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When A-Sp ,//.z .A-71013 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) ND 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/taxidrivtadg 03/2013 7 - I hereby certifythat I haye issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 3 0:),_ E.�1 14b . 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 b Gw 1v,/e774ccc.„l„D Date /7/._3/i ********************************************************************************************************************************************** STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by 7ckJ; cc) '�, 1ic..\_)..) .,e 5 . On this I 'j+t day of _..;21"",.of .YER C. mission Number 729428 • My Commission Expires Notary Public in a for the State obia ************************************************************************************************************************************************ 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). ir%/r /—/7-1 Signatur- of Poli.py ief 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. Signat 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 clerkitaxidrivbadgeapp2010.doc 03/2013 Page 1 of 2 .111Iowa Department of Transportation 11 Office of Driver Services (Toll Flee)800-532-1121 PO Box 9204,Des Maines, IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/9/2014 DL/ID #: 302AE9146 (IA) Customer#: 5468656 Name: Hawkes, David Class: D ID Status: None Raymond Sr Address: 1515 PR DU CHIEN RD Audit#: 7025179 DL Status: VAL TRLR 7 Issue Date: 06/11/2013 CDL Status: None City/State: IOWA CITY, IA Expiration 02/23/2014 CDL Cert None 522455620 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 1515 PR DU CHIEN RD Restrictions: NONE Restriction None TRLR 7Date of Birth: 2/23/1956 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522455620 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 04/02/2009 04/20/2009 M14 Fail to Obey Traffic Sign/Signal Johnson IA 04/22/2009 05/18/2009 S92 Speed Johnson IA 06/06/2009 06/25/2009 592 Speed (10 mph&under in 35-55 mph zone) Johnson IA 11/12/2011 12/26/2011 F04 Seat Belt Violation Johnson IA 10/20/2012 11/26/2012 M14 Fail to Obey Traffic Sign/Signal Johnson IA 11/23/2012 01/15/2013 M14 Fail to Obey Traffic Sign/Signal Johnson IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 04/24/2013 06/10/2013 D53 Non-Payment of Iowa Fine IA IA Name: Hawkes, David Raymond Sr DL/ID: 302AE9146 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: • 1... t4,,,y4 IOWA ss'', A',D. 0. T.?e% 1/9/2014 1/9/2014 Page 2 of 2 � . itaiLa Office of Driver Services Iowa Department of Transportation Name: Hawkes, David Raymond Sr DL/ID: 302AE9146 1/9/2014 KJan. 13. 2014 9 : 18AM Div of Criminal Investigation No. 6506 P. 1/3 .Jen. 7. 2014 1 : 49PM City Clerk - City of Iowa City No. 4174 P. r,r,u, STATE OF ®Wt1NY r:/: 71i, •iur_i V`', Criminal History Record Check ;IUPIA 1 ;Vti.-n - AY Request Form OCtAccountNumber: 1 (Do "F (Ifapplicebio) To; Iowa Division of Criminal Investigation From: City of Iowa City Support Operations Bureau,Irl Floor City Cleric's Office • 215 E,90'Street 410 B.Washington Street Des Moines,Iowa 50319 (515)725-6066 Iowa City, IA. 62240 (515))925-6090 Fax )'hone; 319456-5041 - Pa Y: 319-356.5497 I am requesting an Iowa Criminal Histo Record Check on: ]Last Name (mandatory) Frst Name(mandatory) Middle Name(rccommendeo Date of Birth(mandatory) // Gender(=moiety) Social SecurllyNumber(recommended) 2 2 3 — —570 ilMale ❑Female S O G ---IG --232c) Waiver Information/Withouta signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692,2.For complete criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request. Waiver Release;r hereby gtra permission for the above requesting official to conduct an Iowa cantina,historyrecotd cheekwith the Divlslan of Criminal Tnvealigation(DCI). Any criminal history date concerning me that is mai:naia d by the DCt may Do released as allowed by law. Waiver Signature: OGun a,' "4 ' ° (-1 c7------ • Iowa Criminal History Record Check Results (DCI use De As of k /3 -a Of/y , a search of the provided name and date of birth revealed; rR 4— / < • t VNo Iowa Criminal History Record found with OCT fir I I t1 r>y _SCI :9 0 Iowa Criminal Histoty Record attached,DCI# 0 N OCT initials P PAroi1/od'riTma7 Jani^ellq)9614 1 :4RPM No. 9980