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HomeMy WebLinkAbout19-032� r 1 CITY F IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX Last 1. Name (REQUIRED) 2. Address (REQUIRED) _ IDENTIFICATION NO. is—D �io7 (Office Use Only) FILE® APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police DepartmeA lReyililAGust be made between 8 a.m. to 3 p.m., Monday — Friday) First Middle Irv- �� pft, olS 5 prat -9 Ai -c' 3. Contact Information (REQUIRED) Email: til ��lRb W • (Lr l Cell Phone: II written comrdunication sent via email) 4a. Driver's License expiration date (REQI b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: L heLA Ll 1X11 [&9& -:'(Pira s PxA ball teas h.41!1� _ � .-Ir 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? — Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Gui ty / ,Other 7. Have you been arrested / charged with any traffic offenses in the last five years? �I W TVDe of offens � Where When YailgoqD 11K �r��� 1T�1_19 ZDlto What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspend lead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked int /� e e years? / 10 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) (VD AND 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 1 have issued to me by the Iowa Department of Transportation a valid Driver's license number 1c�t 44 $lora issued on Q%1,4bIllexpiringon $) ]4j a� . 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 gree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisos of Title 5, Chapter �f the City Code. (Needs to be signed in front of a Notary Public) Signature of Date L)_)p-�� APR 10 1019 STATE of ioY Cle �r,k.,.... COUNTY OF JOHNSON ) Iuwa City, Iowa Subscribed and swTg[ to before me by S uRKe a. I on this / day of �V1 I LT ,fes VNE14DY S. MAYOR 231 No u i�te of Iowa 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 date of Driver's license Signature Of�olic 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. urrice use umy Approved application DCI report State certified driving record Website update GerkRAXIDRNBADGEAPPL92018am ded.WC 04/2018 QJ'UWAD0T SWRTER I SIMPLER i CUSTOMER DRlVEff / IOWBC�Ot.gOV Driver L Identification Services PO Box 92011 Des to Anes.. IA 53X6-Y2d4 Plane 615-211-91211 Fax 51'.-239-1837 Certified Abstract of Driving Record Inquiry Date: 3/25/2019 DL/ID #: 769yy8106(IA) Customer #: 4294973 Name: Paisley, Joanne Class: C ID Status: None Marie Address: 615 S Governor St Audit #: 2415686 DL Status: VAL Apt 9 Issue Date: 12/26/2017 CDL Status: None City/State: Iowa Clttyy IA Expiration Date: 08/24/2025 CDL Cert Status: None 522405670 Endorsements: NONE CDL Med Status: NoF E® I L Mailing Address: 615 S Governor St Restrictions: Corrective Lenses Restriction None Apt 9 Supplement: Date of Birth: 08/24/1971 APR 10 Zglg Mailing City/state: Iowa City IA 5224056=0 Sex: F City Clerk History Information Iowa CItY, Iowa Convictions Citation Date Conviction Date ACD Ex lanation County 3UR 03/10/2016 04/19/2016 M14 Fall to Obey Traffic SI n SI nal Johnson IA Name: Paisley, Joanne Marie DL/ID: 769yy8106 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: Name: Paisley, Joanne Marie DL/ID: 769yy8306 3/25/2019 c7- Driver & Identification Services Iowa Department of Transporation FLED APR 10 ?019 City Clerk Iowa City, Iowa Ma r. 29. 2019 4:48PM DCI IOWA 03/2512018 12.01 Yellow Cab No. 2638 TAN}319 338 2708 u STATE ())F J () WA APR 101019 Criminal history Record C484 C/er Request Form i0 a Cit, Iowa I To;, Iowa Division of Criminal lnvertilation Support Operations Bureau, I'r door 215 B, 7"' Street Der Moines, Iowa 50319 , (515)725-6066 (515) 725-6080 Far I am requesting an Iowa Criminal Niatnry 12nn6rt rl,Mte N. lib P.0021002 'DCI Account Number. 9967-F --r (il'eyvlieebb) From: 'Yellow Cab of Iowa Ctty P.O. Boz 428 %wa City, TA.. 52244 (319) 338-9777 Phone: Fuz (319) 339-7302 Last Name (mendate y) ?PA :First Naloae (nenaam • • Mi dIe N e recommended) bate of Birth (maiwaa `'Gender mann Social Sxn Number uuommeeded ❑1Viale I�L('etaale �, O, ©�1 � 3 Waiver InfOr)natiOn: without a signed vMver from the subject of the re"wt,a h:ompl¢te erlminal history record may not be releasable, per Code of Iowa, Chapter 682.2, For complete criminal history.recoro InforalWon, ry allowed by law, always obtain a waiver signature froitl'•the'lmb eet,'of the r nest W41Y6r Iie16&Se: i hereby g(vc permission tof the aborc rogorsting oSlcial tc an to oNminai hlaoty record cheek with the Division of Criminal Invatignaoo (DCT). Any mlminal hhtory dela oonoc i e me that is maintain1ed by D mey be rcteasrd as alloweii by low. FYatver Signature: IFIL vwa lumal.msTo ti.ecolre L;neelc.tcesuits (Det uae only) As of 3 l, qlla search of the provided name and date of birth revealed: TATE OF IOWA/DPS No Iowa Criminal Tiista f Record found with DCI MAR 2 b 2019 r• Iowa Criminal, History I-ecOrd ditached,•DCI # D1 OF CRIMINAL INVEST DCI Itiltlals r r)CI-77 (08/25/10), R.f.;voA Timo Mi r 7l, '701011.6AAlU Ne 1;67 , Mar.29.2019 4:48PM DCI IOWA No.2638 P. 2/5 DISCLAIMER 1/C APR 10 ?Oig This response can only Include public criminal history data. CWMost juvenile records are confidential. Confidential juvenile court records, anot 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 tiled 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: httpJ/www.iowasexotrender.com/. However, even though some information Is available on this site, the actual records forjuveniles 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).