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Home My WebLink About19-033CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-5040 (3 19) 356-5497 FAX Last 1. Name (REQUIRED) IDENTIFICATION NO 17 033 (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 First J05e;o,�, Middle Wkltw 2. Address (REQUIRED) 83�- L u&- Si-,Tuu-�Ufiy, =r9 5-ZZYc�? 3. Contact Information (REQUIRED) Email: wl ({o5' L-- L,,..f-w ;/ - coi., Cell Phone: 31Y. S9y_-2 �" S I written communication sent via email) 4a. Driver's License expiration date (REQUIRED) t/_ .2 3 - „2 J z 5— b. Taxicab Business Name (REQUIRED) `C/LCS,,. G, b a 4- Z oL. 5. Prior experience in transportation of passengers: h To w Cr 1,0 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? AL o Type of offense What happened to the charge? (Circle one) Convicted Dismissed Where When APR 19 2019 Iowa Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? `V 0 Tvce of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ry L) 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) (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 Iowa Department of Transportation a valid Drivers license number Lz') 4 C 5 y -7;z issued on 4 � /- :2 opexpiring on 14.2 s. doz s . 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 provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant '_JVJ � Date 2/ J � • 19 FILED APR 19 208 ,"»City er STATE OF IOWA ) COUNTY OF JOHNSON ) Iowa City, Iowa Subscribed and sworn to before me by \1 s �yL W L g sk o on this \�� day of i.Pr,\ _.Xck°� Of 113 110 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 Drive. icense Sign le o olive Chief or designee oy -E S__ Z S - 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. Office Use Only Approved application DCI report State certified driving record Website update y-- /1-1 � Date Gey Nmimiv&ADGEAPPL92o18amergen Doc 04/2018 ARTS Page 1 of 2 C,J10WA00T'-1' WWW.IgWaCiOC.g:OV SMARTER I SIMPLER I CUSTOMER DRIVEN Driver b IdnU7fitation igryiCu PO B" 92041 Des 11010ine5, IA 5D3013-92114 Pilate: 51524491241 Fac 515-M9.1037 Inquiry 4/19/2019 Date: Customer 5231945 Name: Laskowski, Joseph Walter Address: 836 WALNUT ST City/State: IOWA CITY, IA 522403340 Mailing 836 WALNUT ST Address: Mailing IOWA CITY, IA City/State: 522403340 Date of 4/25/1973 Birth: CDL Permit Sex: M Certified Abstract of Driving Record DL/ID #: 127AC8472 (IA) CDL Permit Class: None Class: D Audit #: 1761773 Issue Date: 04/21/2017 Expiration 04/25/2025 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: ID Status: None Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Laskowski, Joseph Walter DL/ID: 127AC8472 (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: Name: Laskowski, Joseph Walter DL/ID: 127AC8472 (IA) 4/19/2019 V Driver & Identification Services Iowa Department of Transportation http://172.29.254.55/drivers/reports/customerhistory/certifreddrivingrecord.aspx 4/19/2019 04/Ao r 11, 201.91:L.3 :18PM Cab DC I IOWA (FAM193382No. 4920 P. 1/2 /002 ?' STATE OF IOWA Criminal History Record Check ' Request Form To; Iowa Division of Criminal Invest iEagon Support operntlons Bureau, I" ?icor 215 E. 7" Street Aes Molnts, Iowa 50319 (515) 725-6066 (535) 725-6080 Par i, am requesting an Last Naine ra"., DCX Aecouar Number: 9967_F .f — (if appllcohlc) From. _Yellow Cab of Iowa city P.O. Box 423 ]fotva City, 7A 52244 (319) 338-9777 Phone; Fax,- (319)339-7302 �.aslca�sl.�; • • I:: Soso/ � �� (+�✓.. _ . __._.___.. .. .._T -c - _. ...•r}. y..._v.....�i eyLiv_uuauw tf DY . a2 ls--19 73 iMale Onemale ! 4 fT J .Z 33. / rrarver LnJormatiorr: Without a signed ivalver from the subject of the reggest, a cotnplgte i rlminal history record may not be releasable, per Codc of Iowa, Chapter 692.2. $or l;Qmnlete criminal history -record informative, as allowed by late, Nwayo obtain a Waiver slpnature tl'..om,the subiecC of tho roeuAkr Waiver Aeiewe:I horobyyiva pamilrslon for the above requesting official to aondncl an Iowa criminal hutoryrecord eheckwith rbc Division of Criminal inveapgation (DCT). Any criminal hlawry data conoamlri' yPv hn It melnralne4 by tho DCI may bo mlosaod at aflov o04 by low, Waiver ovva grimIRLI-R—istgry Record Check Results As of 'I a search of the provided name and date of bu-th revealed: Iowa Crirainal astoP Record found with DCI c e ,J ® Iowa crimin4 Uistory 4ecord attached,'DCI 9 DIV V , DCIitiitlalsO-� DCI>77 (OB/25/10) Received Time Apr, 5. 2019 9:218M'No, 3709 (DCI asc only) OF IOWA/DPS APR 0 5 2019 CRIMINAL INVEST Aor.11.2019 3:18PM DCI IOWA No. 4920 P. 2/2 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 232.947(98). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry: http://Www.iowasexoffender.com/. However, even though some information is available on this site, the actual records forjuveniies 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 232.947(98). I