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HomeMy WebLinkAbout18-114� r t CITYIOWA CITY 410 East Washington Stmel Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX Last 1. Name (REQUIRED) _ IDENTIFICATION NO. M a _f Lj (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 application 2. Address (REQUIRED) 3. Contact Information (REQUIRED) Email: First I , , Middle 4a. Driver's License expiration date (REQUIRED) I a1 I �2S b. Taxicab Business Name (REQUIRED) (P_��IC 0 5. Prior experience in transportation of passengers: } 2!A� Cell Phone: ' 2.6;2 ,1 -0� email) 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? � ( Type of offense What happened to the charge? (Circle one) Where When cn Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? O� Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty he _ 8. Has your driver's license or chauffeurs 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) FOR 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 upofj raga. I hereby rt' th t I hav Issued to me by the Iowa Dep rtment of Transportation a slid Drivers licen a number ��-7l issued on2l expiring on I �tderstand that if I falsely answer any questions in this application, that this application may be denied. I agree t at in making this application, 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 provisions of Title 5, Ch ter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Appli Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by t I LA N 7P u on this zaa day of MNDY S.MAYER �tW01 Noni°�' �2e Notary Publi n an for the S e of to 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 Cade). Expiration date of Driver's license �a?jaS� Signatur I r designee ��te 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. of City Cleric or Office Use Only Approved application DCI report State certified driving record Website update /�? - 7-/g" Date Qe A%IDRNBADGEAMI_92078amaMr.M.DOC /201 8 J 410WADOTd SMARTER 1 SIMPIER 1 CUSTOMER DRIVEN www.iowadot.gov Diner 810xM18catlon S6rvi Pb Box 9806 I Des Moines. IA SOOD&WU Phone 5115-264-9124 1 Fax 515-239-1897 Certified Abstract of Driving Record Inquiry Date: 11/30/2018 DL/ID #: 577AH3177 (IA) Name: Pulley, Regina Class: C Latanya None Address: 2452 WHISPERING Audit#: 1648434 None MEADOW DR Restriction None© Supplement: Issue Date: 03/02/2017 City/State: IOWA CITY, IA Expiration Date: 02/27/2025 522406805 Endorsements: NONE Mailing Address: 2452 WHISPERING Restrictions: NONE MEADOW DR rn Date of Birth: 02/27/1981 Malliny IOWA CITY, IA Sex: F City/State: 522406805 History Information CLEAR DRIVING RECORD Name: Pulley, Regina Latanya DL/ID: 577AH3177 Customer #: 5922476 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None COL Med Status: None Restriction None© Supplement: Com") I rn � o J Pursuant to Iowa Code §321. 10, I, Darcy Doty, Director of 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: �Qpp�w.f HT Or 'n54S�G 11/30/2018 O �t 75 "Oatal k do Driver & Identification Services tCr4L DDO Iowa Department of Transporation Name: Pulley, Regina Latanya DL/ID: 577AH3177 1 2 201.8,111: 0 AM Cab DCI IOWA - - .. Tdr . Mwil 0or Des w1a tii 10'.". putar I:A*319 338 2N 3 7 5 0 P. . 2/31/002 4- -STATL? Of IO -WA. R - .ry,'' aeard Cheek DICI.A-wount N=ter: _9907-F w"VQ*i;5,— firux.. YjW Cab 6f 14ft 0 p:Box428 Vwctln LL 5r"4 (#14).33`8-9'X77 paa (310) 339 -INN I OWsle IL .1 kr N. id; hk.� . O.'s etc b&r*le&Sik le�.Rek, Oedo;of bqpj, C reeord,.msty 130t 0jb",fi_.. Cr �6atioryas aftwbd by.j*,w, ajyvays godrse rr;� COT 4 (DCI use AS of, Nbluwlt C6niud agory Re,;ord found with DCI Iowa crtrrinal frurory p r ached, L Dd- Cl __j I -I-) 3 dIlltlt� cn NJ Received Time Nov.30. 2018 12:03PM No.3067 Oec. 5.2018 11:09AM DCI IOWA No. 3750 P. 3/3 DISCLAIMER This response can only include public criminal history data. Under Iowa law, most Juvenile records are confidential, Confidential Juvenile court records, If any, cannot be included in this response. A signed release authorization is not sufficient to obtain this information from the Division of Criminal Investigation. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry: http.'Ilwww,10waseyoffender.com/, However, even though some information is available on this site, the actual records for juveniles may still be confidential and any confidential juvenile records cannot be provided with this record. in order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). N O GO Cn .' (7 a -ate J r Ul J