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HomeMy WebLinkAbout19-041e IDENTIFICATION NO. Iq —C>q l r 1 (Office Use Only) ._ APPLICATION FOR TAX pB ED PEDICAB VEHICLE DRIVER (Police Department review mus 9� BI�dA�etween 8 a.m. to 3 p.m., Monday - Friday) CITY OF IOWA CITY 410 East Washington Street rauure to Complete the "re edyr tion will result in denial of thea lication Iowa City, Iowa 52240-1826 it)i 17.9 (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name (REQUIRED) ON2 L t S F rov.'So. 2. Address (REQUIRED) 1 2o D; F\ p N ST T -o C (-r y r- A S LZ y p 3. Contact Information (REQUIRED) Email: a CkC. m (aea I q Q C➢ VpW oo. r..., Cell Phone: �I i. ?. S Y-2 5 (All written communications nt via email) 4a. Driver's License expiration date (REQUIRED) I Z 1 Z`'/ 202 3 b. Taxicab Business Name (REQUIRED) yellow C (Y(.. 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? _),l C-) Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? ►J U Type 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? 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) No, (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 Driver's license number (DU si_ issued on o 1 I i b)/v expiring on i& IZ.y Z7\ . 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 provision of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date 20 141 #4)'03 9n.. STATE OF O owa COUNTY OFJOHNSON )) Cetylk Iowa Subscribed and sworn to before me by Lt-- 1 rj A (a e l;r la ron this r day of Mrs, zc�l4 r4 .S.MAYFJt the Stale 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 date of D er's license Z Z I/- Signat 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. fold Office Use Only Approved application DCI report State certified driving record Website update aeM1✓rAX1IXiN94DCEAPPL92018ertcnE DOC `J-3 -1 ri Date 04/2018 „.,May. 1 2019v,11:54AM�,a,k DCI IOWA 3,9 3686497 04/26/2019 ,3;61No' 9424105p. 1]2/002 . STATE OF IOWA "`` Criminal History Record Check r' Request ]Form To: Iowa Division of Criminal Investigation Support Operations Bureau, 11” Floor 2151. 71° Street Des Moines, Iowa 50319 (515) 725-6066 (515)725-6080 Fax I am renuecdne an Y.. f4iminel U.'e ..., n..,..a rs.e.a..._. al. j DCI Account Number: Ko�yrr Of applirsbk) From: City of Iowa City City Clerk's (Noce — 410 R. ashington Street Iowa City, IA 52240 Phone: 319-356-5041 Far: 319-3564497 Last Name mu,datary) First Name (mandatory) Middle Name (reonimtn den) `� _3_� O .c fn e Date of Birth (mandatory) Gender (mandatory) Social Security Number (rcoomma,dra) Z l 7j LylYlale (�Femalc S_ S S } 33 'T, WaivekInformation: Without a signed waiver from the subject ofthe 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 bylaw, always obtain a waiver sipature from the subject of the request Waiver Release: 1 hereby give permtsaion for a c above "itu4ting official to conduct m lows criminal history rcaud check wills me Division ofCrimiml lnvutiaerim (DCq. Any aiminal history dela wrn ping me [hat is main siued by the DCI may be felc=d w allowed bylaw. Waiver Signature: t,t:t V � U Iowa Criminal History Record Check Results ([)—only) `� _3_� O fn As of a search of the pivvided name and date of birth revealed: n n i � � m No Iowa Criminal History Record found with DCI to ae o © Iowa Criminal History Record attached, DCT # m ° DCI initials• rn y fn Ut]-//(Ue/L]/AU) Received Time Apr, 26, 2019 1:50PM No, 8409 May. 3.2019 11:55AM DCI IOWA No. 9424 P. 2 DISCLAIMER This response can only include public criminal history data. Under Iowa law, r&VO 3 1019 juvenile records are confidential. Confidential juvenile court records, if any, cannot be included in this response. A signed release authorization is not sufficient to o6thidthis,, 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://www.lowasexoffender,coml. 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 flied pursuant to Iowa Code section 232.147(18). ARTS Page 1 of 2 r k C210WADOT X9'19 9 SMARTER I SIMPLER I CUSTOMER DRIVEN uvww•lowado� v DFWW s PO Box 9204 I Des Mores, IA Ph": 5152449124 i Fact: 515-M I a Inquiry 4/26/2019 Date: Customer 406903 Name: Chay Escobar, Luis Alfonso Address: 1206 DIANA ST City/State: IOWA CITY, IA 522404629 Mailing 1206 DIANA ST Address: Mailing IOWA CITY, IA City/State: 522404629 Date of 12/24/1963 Birth: CDL Intrastate Only, No Sex: M Certified Abstract of Driving Record DL/ID #: 555XX6834 (IA) CDL Permit Class: None Class: A Audit #: 9688823 Issue Date: 01/06/2016 Expiration 12/24/2023 Date: Endorsements: Passenger Restrictions: CDL Intrastate Only, No CDL Permit Class A Passenger Restrictions: Vehicle Restriction None Supplement: History Information CLEAR DRIVING RECORD Name: Chay Escobar, Luis Alfonso DL/ID: 555XX6834 (IA) CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: VAL CDL Permit ELG Status: CDL Cert Status: Non -Excepted Intrastate CDL Med Status: None 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: 4/26/2019 d9 VL saw Driver & Identification Services Iowa Department of Transportation httD://172.29.254.55/drivers/reports/customerhistory/certifieddrivin2record.asi)x 4/26/2019 r\71K Name: Chay Escobar, Luis Alfonso DL/ID: 555XX6834 (IA) Page 2 of 2 http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 4/26/2019