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Home My WebLink About19-047i CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)3S6-5040 (319) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. C1 — (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 ,4 rtCEs /1//,Cquc4 A• 2. Address (REQUIRED) 3-� 3. Contact Information (REQUIRED) Email: (2r/ o^(es /C ® ,trs v communication sent via 4a. Drivel's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) J 2�/u CaS 5. Prior experience in transportation of passengers: C45 dvl.,a 50?.2 Cell Phone: 319"-/7/ -J./75- 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? 40 Type of offense Where When 4 3 1 J F- .. What happened to the charge? (Circle one) >- o Convicted Dismissed Deferred Suspended Plead Guilty Other w Have you been arrested / charged with any traffic offenses in the last five years? %!tS 01 Type of offense Where When .:c4/ %L� Jl�n ib'r �6 S�O%7 •i<. 7oznsc , the charge? (Circle one) Convicted Dismissed Deferred Suspended ead Gul Other 8. Has your drivel's license or chauffeur's license been suspended or revoked in the last five years? A 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) h G (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 j You must apply for an individual Department of Criminal Investigation Report (form avaitabte uiiap requ,90). I hereby certify that I have issued to me by the Iowa Department of Transportati n a v river's licm number issued on 7 �v/S expiring on /41 e2d' I�dersp2"riyt that if I falsely answer any questions in this application, that this application may be denied. I agree that'=,�triakir-Sthis application, I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to examitSeahy aM all records and documents relating to this application, and I further agree that, if authorization to be a taxicab driveris grant¢; 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 ApplicantTDate r/1` STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by M WI -AQ A,. i 4 r ieS on this ) -7 day of 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 li nse 0� �� ✓ Z� 7-4, 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. Office Use Only Approved application DCI report State certified driving record Website update (O—I_"q Date CleMIrAXIORIVBADGE PPL92018am ndWd DOC 04/2018 ' Z A DOT �� L1natiMJ IDWBCjat nog Inquiry Date: Name: Address: City/State: SMARTER I SIMPLER i CUSTOMER ORNH Explanations Wiwi S Idsn44lic 16isry Downgrade PO &x 12041 Des ticines- ii4 421k Phone 01/15/2018 515-2.44-91241Fax 5� -fF? IA S93 Speed Johnson IA Certified Abstract of Driving Record 05/03/2017 ` F04 Seat Belt Violation 5/28/2019 DL/ID #: 228AD8474(IA) Customer #: 'y687190� IA Earles, Michael Allan Class: C ID Status: None 10/23/2018 32 GLEASON DR Audit #: 2874543 DL Status: VAL Improper Lane Use Issue Date: 06/07/2018 CDL Status: None IA IOWA CITY, IA Expiration Date: 06/16/2026 522405838 Endorsements: Mailing Address: 32 GLEASON DR Restrictions: NONE NONE Date of Birth: 06/16/1956 Mailing IOWA CITY, IA Sex: M City/State: 522405838 CDL Medical Examiner's Certificate CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Certificate Specifics Explanations Type Downgrade DowngradeStartDate 01/15/2018 IssuingStateCode IA History Information Convictions Citation Date Conviction Date ACD ExPlanation Coun JUR 03/08/2017 04/03/2017 S93 Speed Johnson IA 04/08/2017 05/03/2017 ` F04 Seat Belt Violation Johnson IA 10/03 2018 10/23/2018 M40 Improper Lane Use Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date - Case Number JUR 03/08/2017 972671 IA 09/24/2018 1069188 IA 10/03/2018 1071529 IA Name: Earles, Michael Allan DL/ID: 228AD8474 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. O In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, a 5;4nkeny,,;[gyva this date: p v 1 { 4I* ur•�'S4 5/28/2019 s ?J r el Name: Earles, Michael Allan DL/ID: 228AD8474 Driver & Identification Services Iowa Department of Transporation Jun. 3.2019 4:34PM DCI IOWA 0512812019 13:40 Yellow Cab STATE OF IOWA Criminal History Record C • Request ]Form ACI A= To: Iowa Division of Criminal Invesdgedon Support operations Bureau, I' f'''loor Frnm. 219w T" Street D" Moines, Iowa 50319 Iowa City, IA 52244 (515) 725-2 6066 (515) 725-6080 Fax (319) 338-9777 No. 3882 P. 1/2 ffA10319 338 2708 P-0021002 Phone• FaX: (319) 339-7302 I am reauestin& a.. T.,-- - - - - » -- ow. •%o ku uocx on: )✓aat Name (mandatory) `Flrat Nerve' endato Middle Name (moommonds ,eA2L.S.r Ae-0VA jL AAle� Date ofBiYtlt(mudotory) ;iGettdaY mmdam P$OGialSOC41i I�IllmbCY rxannwnded) Male ❑Female aLi�1S� Waiver lnfo7an io:.Without a signed'walver from the subject of the request, a complgte;Aminal history record may not be releasable, ode oflowa, Chapter 692.2. For complete crimioai history. record Information, as allowed by 1zw,10ways obtain a waiveture from the sub Oct of the re uast Waiver Aeleasp: I harrby jive perm Wlon tbt the above mgvrsting offias) to conduct ee lowa ulmtnd.putory ramrd nhtxk �%rdt ttw Divifita of Comhtal lnvedtigation (DCT). My erim5al bietory data ooOMMIIRS MO that ie mabnatncd by the DCl may bo released as;dlowoll by law, Waiper Signature; DCI -77 (08/25/10) RprPivAd Timp Mav 99. 11119 1-140M Nn. M1 Iowa Criminal Aisjt2iry Record Qxeck.Results �[pCi uce on, As of a search:. of the provided name and date of birth revealed: 0D �t 3 y O I No lowa Criminal Hist oty Record found with DCI z O o r o ❑ Iowa Criminal Mstory Reeord attached, DCI #y co iifitials .i DCI DCI -77 (08/25/10) RprPivAd Timp Mav 99. 11119 1-140M Nn. M1 Jun. 3. 20 19 4:35PM DCI IOWA No. 3882 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 232.147(18). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry. htt .*IAvww.iowas exoffender 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 tiled pursuant to Iowa Code section 232.147(18). N O_ ..O :<m a_ w