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Home My WebLink About19-044CITY OF IOWA CITY 410 East Washington Strcct Iowa City. Iowa 52240-1826 13 19) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) _ IDENTIFICATION NO. P — Q Ll y (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 Last First Middle T sa-cl�rlA,, Ater lm;cx'Ei jq717 lig.Ai) �-C - rJ y 2 3. Contact Information (REQUIRED) Email C (Ifs 6D hone: Cell Phone: -319-327-32:7-3 (AVmitten communication sent via email) 4a. Driver's License expiration date (REQUIRED) 0//Z��c� b. Taxicab Business Name (REQUIRED) y��(ilti l 5. Prior experience in transportation of passengers: /IOrI 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended ead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? Q Tvoe 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,`su�pgrjg" 1jerevoked in the last five years? /7 /J Tvce of offense )? }� 1 (' I When 9. Have/ you ever applied to be an Iowa City taxi driver usir=g�a 4eri t �1'ame? If yes, please provide the name(s) l� (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER 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 Departm nt of Transportation a valid Driver's license number issued on �%/�>expiring on 0�� ? 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 gf Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicantr�/%�/(J�!/ Date t�— 4/ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed answorn to before me by trip a ,I Lar tA . K . -To 5 $ on this Zo day of VMNDY S. AIAYER CamY N Nmrou 72tir2ti No ary Public and for the State of wa m++r++++++Tema+++++++++rwm+++++++++++++++r+a++rr+++++++++ 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). GI• zo Zezf- -ql of Police Chief or designee r;C-2 -iq 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. Signaty Clerk k odesig� sI---).oIII Date Office Use Only Approved application )121 DCI report 9 lad oZ k�� 61DZ State certified driving record ' S : Website update GeM/rAXIDRNBADGEAPPL92018anWXW ooc 04/2018 May 12019 11:58A1� DCI IOWA 041+�ur .V r a vo.va 1 o■v Cab M1 STATE OF IOWA 11 1HistoryRecord .i1.s,,L1 i Request1 11 e xo: Iowa Division Of Criminal lnvestjgation Support Operedons BureAa, I*t1oor 215 L. 7" Street Des Moines, Iowa 50319 (515) 725-6066 d. (515) 125-6080 Fax ff )09 3382Nw 9127 " J021002 DCI Account Number: 9967—F • • (if appLiceble) Frons: XelIOW Cab of Xowa City P.O. Box 428 Iowa City, IA. 52244 (319) 338-9777 Phone: Plx: (319) 339-7302 -— w.+.^a �.ruuweu rust � aeord Check on: Last-N-aluee manual, First N me mantle 10 ' Middle Name heeemmn d,d) DAte/YBirth . p :Conder mandato Z'o ✓"0 I 9J So/ciia`l�socul'-'7 Numbeer(rerommeee I ;aje ❑Falnale v/ / lJ �L. �(� �� e r6le r able, per Code Without ktl{ned )valvar from the subject of the request, a Complete criminal history record. rpay not be releasable, per Code of low*, Chapter $92.2. ForS6tmulete criminal history -record in(ormation, ■a allowed by law, a )ways obtain awaiver si naturefrom•thesub ectl)fthe r nest ff"Z tr Release: I hereby give pemWinn for eho ebove requcsting official to eondurx eo Tom criminal hierury record a=k v�tth 1b, Dlvalon of GYlminai lnvudgition (DCI). My orlmin"I hleeory den,onceming me that Is malmolned by the ACI may be re)eaeed u ellowrq by law. Waiver z ZOwa Cstory Record Check R ults �6= Yw only) As of a searchof the provided name and date of bh-th toyaled: O y No Iowa Criminal Histo y Record Fouad with DCI !itii0! z as d r�01113 o o Iowa Cri>ninal I$eforyeeord aifached, DCI # y o10Z z `� >' m 0 rn DCI initials DCI -77 (08/25110) Received Time Apr.26, 2019 7:59AM No, 8330 May. 3.2019 11:59AM DCI IOWA No, 9427 P. 2 DCI:00911449 NAME: JOST,CHRTS JOST,CHRISTOPHER DOB SEX RAC 19920120 M W ADDITIONAL IDENTIFIERS PRCD L EAR SC L ARM SC R ARM IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI 00911449 PAGE 1 OF 2 DATE PRINTED - 2019/05/03 HGT NOT EYE HAIR SKN POB 603 245 BRO BLK FAR IA PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20101005 AGENCY; IA0100100 INDEPENDENCE PD CHARGE NO- 01 IA STATUTE IA714.2(5) THEFT 5TH DEGREE - 1978 TRK#: EJ00IF601 COURT DISPOSITION AGENCY: IA010015J BUCHANAN CO DIST COURT COUNT NO- 01 IA STATUTE: IA714.2(5) THEFT 5TE DEGREE - 1978 COURT CASE ID: 01101 SMCR076645 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: EJ001P601 RESTITUTION SENTENCE DISP EPP DAT FINE $65 20101006 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 but can only be released to non -law enforcement agencies by the DCI. 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://www.iowaeexoffender.com/ . However, even though some information is available on this site, the actual records„f1y,k i 4jtay still be i confidential and any confidential juvenile`"e�oS �as�ot be provided with this record. In order to request the release of confitryle 'j�I juvenile records, if any, an application must be i lgg MrsOWnCYtb" rowa Code section 232.147(18). May. 3.2019 11:59AM DCI IOWA No. 9427 P. 3 IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD I8 9ASkD ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION 0 "'WA DOT A �p OI.A-RIER i SreIPLE i CUSTOMER iD�.l�NEdti �Iii�d.6CY'�1`d3d��,t,�.CiU Driver & Iduadioc"on Services PO Sox 9A4 l Das N'auiila5.. IP. r ",n.m-� FIKAe: 5;5,244-S424 I Fax. a Certified Abstract of Driving Record Inquiry Date: 4/26/2019 DL/ID #: 277AD3908 (IA) Customer #: 5440851 Name: Jost, Christopher Class: C ID Status: EXP Michael Kenneth Address: 2470 LAKESIDE DR Audit #: 2008887 DL Status: VAL APT 6 Issue Date: 07/28/2017 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 01/20/2025 CDL Cert Status: None 522406746 Endorsements: NONE CDL Med Status: None Mailing Address: 2470 LAKESIDE DR Restrictions: NONE Restriction None APT Supplement: Date of Birth: 01/20/1992 Mailing IOWA CITY, IA Sex: M City/State: 522406746 History Information CLEAR DRIVING RECORD Name: Jost. Christopher Michael Kenneth DL/ID: 277AD3908 Vrsuant to Iowa Code 6321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Department of Transportation, :o hereby certify that I am the custodian of the records held by Driver & Identification Services, that this is a true and accurate mpy 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 date: U01 ;1110 bM01 AH310 X1110 IS :8 Wb 03 AN 6192 a3 -1'j Name: Jost, Christopher Michael Kenneth DL/ID: 277AD3908 4/26/2019 Att�Le�241-nx— Driver & Identification Services Iowa Department of Transporation V