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Home My WebLink About19-076CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa S2240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) 3. Contact Information (REC IDENTIFICATION NO. (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 resuh in denial of the application Last First Middle 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passng 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense11 Where When Su%Skit e—C 67,1 res Vi r��C, f 2GU tf N 0 O �o -^r What happened to the charge? (Circle one) <r— /6 — Convicte Dismissed Deferred Suspended Plead Guild_ AtheF — ------ 7. Have you been arrested /charged with any traffic offenses in the last five years? �1 p: = •• b Type of offense Where WheW 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? %I o 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) P / IA �.S �"'I V 1 �6 // #,- ( NOT 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 Department of Transportation a valid Driver's license number 2 "7 q issued on , z 21 xpiring on z / 31_2 b 2,71 understand that if I falsely answer any questions in this application, that this appl cati n may be denied. I ag ee 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) n j Signature of Applicant/ ` Date/6 E 7 Z o / I i STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed obrs� d and �s�worn to before me by Sct n-1 e j �i d GDvv on this 1-7 day of 1,01 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 eYA J Z7 7 hD Signature of Police Chief or designee Date=, --A AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICA&IWIOWAY CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. ,a Signa re of City Clerk or designee Date Office Use Only Approved application DCI report State certified driving record Website update CIeAffA%IDRIVBADGEAPPL92018amended.DOC 04/2018 Oct.16.2U19 11 OJAMuUVW DCI IOWA No 4319 P. 1/2 l0,iwaie its rnauwCab U0193382100 rmuW002 STATE OF IOWA Criminal History Record Check Request Form (Male C1Femele I �Si 07 5- 44 As of a search of the provided name and date of birth P DC1 A000nnt Nnmbor: 9967-F Hail or Fax feted far++ (if*Plicable) com R � ' Send results to: Iewa DlvWon of Grbninal investigation Nome Yellow Cab of Iowa City Support Operations Bureau, la Floor - 215 E.'7's street Address Y.O. Boz 4Z9 Des Moines, Iowa 5o319 (31$) 725-6066 lows City, Iowa 52244 (515)725-6090 Fax "` Phone53191339-9777 - Fax 319.359-4142 (Male C1Femele I �Si 07 5- 44 As of a search of the provided name and date of birth P `�� reyealcq; .'. V.11 No Iowa Criminal Hintory Record 'found with DCI l lel; „` sy c-'+ Iowa Criminal Ffistory Record attached, DCT # e 'a °• "` DCI initials r a DCI -77 (updated 06.26-2018) Page I oft Received Time Oct, 10. 2019 11:14AM No.3421 Oct.16.2019 11:01AM DCI IOWA No, 4379 P. 2/2 DISCLAIMER This response can only include public criminal history data. tinder 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 Investlgatlon. 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. httQY1www.iowasexoffender com1. However, even though some information Is available on this site, the actual records forjuventles 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). N O � C-) lD o i rn ED = Y`� cn "OluvvADOT SMARTER I SIMPLER I (US TOM Fi tivtivw.iowadot.gov E ORi'1Efi Driver B Identification services PO Box 920-11 Des wines, IA IWXA 9204 phone 515-241-9124IFax 51`.-739-1837 Certified Abstract of Driving Record Inquiry Date: 10/10/2019 DL/ID #: 395AR9979(IA) Customer #: 6918730 Name: Thompson, James Class: C ID Status: None Bernard Address: 418 E 3rd St Audit #: 3959979 DL Status: VAL Issue Date: 06/29/2019 CDL Status: None City/State: West Liberty, IA Expiration Date: 02/13/2027 CDL Cert Status: None 527761437 Endorsements: NONE CDL Med Status: None Mailing Address: 418 E 3rd St Restrictions: NONE Restriction None Supplement: Date of Birth: 02/13/1975 Mailing West Liberty, IA Sex: M City/State: 527761437 History Information CLEAR DRIVING RECORD 0 Name: Thompson, James Bernard DL/ID: 395AR9979 ��O Pursuant to Iowa Code §321.10, I, Darcy Dory, Director of Driver &Identification Services, Iowa Q-04nment of Tra ation, do hereby certify that I am the custodian of the records held by Driver & Identification Services, tha�"$ is ague anVdrM �.a��curate copy of an official record currently In the custody of said Office, and that I have been authorized;i DWctor 0 Iowa Department of Transportation to so certify. CA } LIl 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: Thompson, James Bernard DL/ID: 395AR9979 10/10/2019 Driver & Identification Services Iowa Department of Transporation