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Home My WebLink About18-112CITYF IOWA CITY 410 East Washington Stmel Iowa City. Iowa 52240-1826 (319) 3S6-5040 (3 19) 356-5497 FAX Last IDENTIFICATION NO. I g — � I a (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) Failure to complete the "required" information will result in denial of the aoplicadon First Middle 1. Name (REQUIRED) iG k S 36AS Q �\ \'GI )e 2. Address (REQUIRED) a in 11 IJ - SM M„ '4 S1 o vg [- tv , I A- 5Z2 YS 3. Contact Information (REQUIRED) Email: , Lka n l Je Wl C k -S (` i mmi l , c c IA Cell (AII written oommunicatio sent via is email) 4a. Drivers License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: 711ci/Zay( C46 N 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? p J Type of offense Where When What happened to the charge? (Circle one) onvicle Dismissedefered Suspended Plead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? les Type of offense W here When N Z01S ro tali(SttrG�+ty� �1�ht tot C� . X01 � WGlWhat happeppepp{{echarge? (Circle one) SI rnk) C t a Ul onvicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? _ NO 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) N O (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 Iowaepartment of Transporta'on valid Driver's license number _ 2u o .1 t 5('? 16 issued on 112-1 ( 16 expiring on '711 q I 2 I . I understand that if I falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver is granted, to comply at all times with all of the prions of Title 5, Chap r 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicantovis- Date 11 2 1 18 N O O 4 Nf 1f'fl1f1111Nflllff!1111N! f 11MfiYfNyNH1fllNlNNif1N1H1Mylf flN1f11NlNf-f i-11fl1NNf!!Y1!!1f}yNf�IGflyl11fff!lfNlMYMl4N STATE OF IOWA COUNTY OF JOHNSON Subscribed and sworn to before me by ?n a _ Li 1c5 on this ,vim l day of and for the Stag of 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). Expiration dat f rive icense a7-/5- Z / 77 1/ - zG-/d Signet of Police Chief or 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. _ /(-�-w-/(1 of City Clerk or de�ignee / Date Office Use Only Approved application DCI report State certified driving record Website update C36WTAXIDRN -MEAPPL92018amerded.DOC 04/2018 Nov.16.2018 9:16AM DCI IOWA Prom:Clty of Iowa City Clerk Offlom 390 3666487 No. 1480 P. 2 11/13/2019 '15:02 /170+2 P,002/002 STATE OF 10W * A I*, Criminal History Reegrd Check To: Iowa Division of Criminal Investigation Support Operations Bureau, V Floor 215 E, 7'" Street Des Moines, Iowa 50319 (515)725-6066 (515)725-6050 Fax T am reouestino an Tnwa CriminnI Histo v Recnrel Check nn - DCI Account Number: Iq ob F (irappiieeble) From: _CUM of Iowa City City Clerk's Office 410 E. Washington Street Iowa City, L3 52240 Pbone: 319-356.5041 Fax: 319-356-5497 Last Name (mandatory) Mrst Name mandmo ) Middle Name (recommmdtd) 41c<<J JAs,: , YAIC Date of Birth (mandatary) Gender (nlandarory) Social Security Number (recd�mm-a�ided) q 3 L`�iVIale Ovemale 7? i— 0 z^� `4 Gbd) 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. For complete criminal history record Information, as allowed by law, always obtain a waiver signature from the subject of the request. WaiVCI>7eieRSe;l hereby glue permission for the above requesting official to con Investigation(DC4. My criminal history, data concerning me that Lmaintainedbyn9 a )owe criminal hlltory record cheek what the Division of Criminal ray bealeasedasoilowedbytaw. Waiver Signature: 1 ,� Iowa Urxminal MstorV JKecorcI Ul1ee1c.KesultS c ': (Uel aaa Daryl As of I ' ` �' Irl 'I l r i , a search of the provided name and date of birth revealed: No Iowa Criminal history Record found with DCI ;..•; _ Iowa Criminal History Record at ached, DCI I)CI initials DCI -77 (08/25/10) Received Time Nov, 13, 2018 1:24PM No.0899 Nov.16.2018 9:16AM DCI IOWA IOWA CRIMINAL HISTORY DCI 00705854 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 2ATE P 018/11/16E0- DCI:00705854 NAME: HICKS.JASON YALE SEX HAIR SKN POB RAC HGT NOT EYE DOB 19730719 M W 510 150 HAx BRO PA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20030026 AGENCY; IA0520200 IOWA CITY PD CHARGE 110- 01 IA STATUTE IA716-6 CRIMINAL MISCHIEF 4TH DEGREE TRK#: 100939301 COURT DISPOSITION URT AGENCY: IA052015J COUNT NO- 01 IA STATOTE:NSON CO DIA716IST o6(2) CRIMINAL MISCHIEF 5TH DEGREE COURT CASE ID: 06521 SRCROU6291 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100939301 RESTITUTION SENTENCE FINE $50 02 ARREBTED/TAKEN INTO CUSTODY 20070907 AGENCY; TA0520200 IOWA D IA STATUTE IA719.1(1)B CHARGE NO- O1 INTERFERENCE W/OPFICIAL ACTS BODILY INJURY TRK#a IA002AH01 COURT DISPOSITION AGENCY; IA052015J COUNT NO- 01 I.AHSTATUTE:SOX CO DIA719IST 01(1)8 INTERFERENCE W/OFFICIAL ACTS, BODILY INJURY COURT CASE ID: 06521 AGCROB0742 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A002AH01 SENTENCE JAIL SD FINE $625 03 ARRESTED/TAKEN INTO CUSTODY 20100419 AGENCY; IAD520200 IOWA CITY PD CHARGE NO- OS IA STATUTE IA124.401(5) POSSESSION OP A CONTROLLED SUBSTANCE DIRK#; lAo096TOl COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: JA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCRO90556 DISP EFF DAT 20031021 DISP EFF DAT 20071207 20071207 No. 1480 P. 3 Nov.16.2018 9:17AM DCI IOWA CHARGE CLASS: NON CONVICTION TRK#: IA0096TOI SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT COURT COSTS $315 PROBATION lY DISCHARGED FROM DEFERRED JUDGEMENT DCI 00105854 PAGE 2 OF 2 DISP EF£ DAT 20100915 20100915 20100915 20110513 No, 1480 P. 4 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD EUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY DIVISION OF CRIMINAL INVESTIGATION Nov.16.2018 9:17AM DCI IOWA No.1480 P. 5 DISCLAIMER This response can only lncludepuhl/o'tr/minalhfsforydi(d. flnderlowe low, most juvenile records are coliddenflal ConfldenflaijUvenllacourt records,.lfany,cannot be Included /n this responae.:A slOnedrofaa80 authdrizaflon is not SuNclent fo dbfeln flits Infarmafldn from the Dlv/slon'atCrlmfnaf InvosUBatlaq, In order to request fhb release of confldentlalJuveltllerecords; Ifany, an eppllcaHon must be•fl/ed,pursuanf to lows Code. sect(on Z32.i47(1BJ, Additionally, criminal history date Concerning conVlCflons for certelnJuvenlle sex offenses,can be found on tha lowe a K pffender:Registry, tt / ww o 0 0 0 „ fiowevar, aVen fhopgh soma Informaflon Is avel/rSble on th/s s(te, the actu8LMOO • s forJwenl(es rriey still be'conf/dentll l end any ptifldentlal Juvenile records cannot be provided wlfh'lhls record,' In hrder. fo request the release of conNdentlalJuyenlle,reoords, Il any, qn appl(Aatlon mustbe fled pursuant to Iowa Code sectlon 232,147(IS ARTS Page 1 of 2 C21(3-WADOT www.iowadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN Drier& Identification Services PO Box 9204 1 Des Moines. IA 509116.9284 Phone: 515.244-9124 ) FaC 515-23961837 Inquiry 11/14/2018 Date: Customer 3968765 Name: Hicks, Jason Yale Certified Abstract of Driving Record DL/ID #: 290JJ5816 (IA) CDL Permit Class: None Class: D Audit #: 1327395 Address: 1017 N SUMMIT ST Issue Date: 09/27/2016 City/State: IOWA CITY, IA Convictions Expiration 07/19/2021 Date: Endorsements: Chauffeur 3 CDL Permit Issue None Date: CDL Permit 522455938 Mailing 1017 N SUMMIT ST Address: None Mailing IOWA CITY, IA City/State: 522455938 Date of 7/19/1973 Birth: None Sex: M Convictions Expiration 07/19/2021 Date: Endorsements: Chauffeur 3 CDL Permit Issue None Date: CDL Permit None Expiration Date: Restriction None CDL Permit None Endorsements: CDL Permit CDL Permit None Restrictions: Improper Registration ID Status: None Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit ELG LI/29/2016 Status: Improper Registration CDL Cert Status: None History Information CDL Med Status: None -itation Date Conviction Date ACD Explanation JUR County LO/15/2011 01/19/2012 S92 !Speed _ IA _ Johnson__ _ LI/29/2016 _ 4. _y12/05/2016 Improper Registration IA Washington _ L3/29/2016 12/05/2016 X592 i5peed (10 mph & under in 35-55 mph zone) IIA Washington Name: Hicks, Jason Yale DL/ID: 290JJ5816 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, 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: 11/14/2018 �- http://172.29.254.55/drivers/reports/customerhistoryleertifieddrivingrecord.aspx 11/14/2018 .ARTS Driver & Identification Services Iowa Department of Transportation Name: Hicks, Jason Yale DL/ID: 290JJ5816 (IA) Page 2 of 2 http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord.aspx 11/14/2018