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Home My WebLink About21-024L� r 7t CITYF IOWA CITY 410 East Washington Street lorca City. Iowa 52240-1826 (319)356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) �L 2. Address (REQUIRED) IDENTIFICATION NO. _2 I — Q'2q (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 "reauired" information will result in denial of the application Last First Middle 3. Contact Information (REQUIRED) Email: Cell Phone: =— (A mittteeln communicafion sent via email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 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? What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended PleadGuiltyOther. 7. Have you been arrested / charged with any traffic offenses in the last five years? too Type of offense W here When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years Type of offense Where When 9. Havhie you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 04/2018 rX 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 he certify that I have Issued to me by the Iowa Department of Transportation a valid Driver's license number � 9 z1-il67 issued on /0&/()Q/9expldng on 0eral/,-Va3 1 understand that If 1 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 provlsigns o _TAls,5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) 1�11ffll W20 915111, YffMMiHHfHflffff f111f1f fHf fY1f If fMf flffHIMHHHHHH111fHMHHff HffMff,rlHHf.11Mf HNfff„fffHlM,rlf IiHf f ffHilNHfllfMMf STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this Notary Public in and for the State of Iowa day 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 (fitte 5, Chapter 2, City Code). Expiration date of Driver's license 6 Y 1' Z S' 6;� Signature of Police Chief or designee FD 2 1 1011 oZzl•zl Date City Clerk ,,ria City, lour=. 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 C6,WTA, (IDRN 3ADOEAPPLO2Ateamn,dee DOC Date 0412018 Feb.19.2011 12:28FM DCI IOWA No.5011 P. 1/3 0�?J��mws MW i ww Cob 00 6 nB 21w r .wJO it YS"^� iK /7rl;a J. yyII...��{ A ril`� y S a 4 '�k + '.+i,f`+.r* {�J''�M� ' y rt - P.BPy, �• T,,�e ML!" ';' .. ;'. t: Y �Aff ` Y A�w�r `` y✓•Y/by� � r> '�. C% l 1 N � i' t' ../ ...:. 3 i . �r• r -`h •:� ,�,,;�" �. J ' a ; w [ F OF 7 t 1'x....7 (' g,i ; C r/ilI iflul I'8 ign)j'.ti R(T)7'd . 1. hftt t ilta.�.a'�uca�YtnnGtr � Cfk�,'.= yf�✓ ?. L�i , i .___• t1t _-i'2f('. 1 � 4.�.Cx �JI�'C31i u - —'---- � 1__MblJi 1 1:3 r 11. 4dy�"a TS7S72ayL66 ioa�yltq „52241 '•.+n!ef*'''�.�' (sf�►'�x�� daa �� i$'�t97`T�F;.,18w�' - •��'.. J•+.Y�: '+.t�!A�'kM � e{v�JT�.h��ei�.�.d t -Y .,JJr {_ xn:. i ,�.... _':: a a>«x ::_._:M1v....a . � ... 1: NTide !_it '.%••.: '. '•J��uuY '.�'t,`.•` $f ^af,M6,>..�; �i p'� .ra'.'T .�'+r� �:y��ecelv4d..T1.�5�F46..�@ .1�,�.1g1�.1.lAM,No b861:a,�4r.r.�:�1,�•�.a�a��;`�'1e't.:�'?��',:�.,. Feb.19.2021 12:30pM DCI IOWA ADDITIONAL IDENTIFIERS CCH RECORD *"• 01 ARRESTED/TAKEN INTO CUSTODY 19980119 AOBNCYo IA0520000 JOHNSON CO 80 CHARGE NO- 01 IA STATUTE IA236-2 ASSAULT CAUSING INJURY DOMESTIC TRW 016542901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708-2A(2)B ASSAUTL C/INJURY DOMKSTIC CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 016542901 SENTNNCE DISP EFF DAT JAIL 21) 19980626 BATTERERIS ED PROGRAM/NO CONTACT CONT'D 1YR FINE $2SO 19990626 No. 5011 P. 2/3 An arrest without disposition is not an indication of guilt. This record maintained by the Iowa Division Of Criminal Investigation, Bureau Of Identification is a public record but can only be released to non -law enforcement agencies by the DCL. FL3 21 2021 City Clerk Iowa City, Iowa This response can only include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidential juvenile court records. If any, cannot be included in this response. A signed release authorization is not sufficient to obtain this information from the Division of Criminal Investigation. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry: http://www.iowaaexotfender.com/ . However, even though some information is available on this site, the actual records for Juveniles may still be confidentlal and any confidential juvenile records cannot be provided with this record. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(16). IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD I$ BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS TRB SUBJECT OF YOUR INQUIRY. IOWA CRIMINAL HISTORY DCI 08568054 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2021/02/19 DCI:00566054 NAME: NORDRN,ERIAN TIIOMRB DOB SEA RAC HGT NGT EYE HAIR SRN POB 19760621 N N 509 215 HAZ SOY FAR IA ADDITIONAL IDENTIFIERS CCH RECORD *"• 01 ARRESTED/TAKEN INTO CUSTODY 19980119 AOBNCYo IA0520000 JOHNSON CO 80 CHARGE NO- 01 IA STATUTE IA236-2 ASSAULT CAUSING INJURY DOMESTIC TRW 016542901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708-2A(2)B ASSAUTL C/INJURY DOMKSTIC CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 016542901 SENTNNCE DISP EFF DAT JAIL 21) 19980626 BATTERERIS ED PROGRAM/NO CONTACT CONT'D 1YR FINE $2SO 19990626 No. 5011 P. 2/3 An arrest without disposition is not an indication of guilt. This record maintained by the Iowa Division Of Criminal Investigation, Bureau Of Identification is a public record but can only be released to non -law enforcement agencies by the DCL. FL3 21 2021 City Clerk Iowa City, Iowa This response can only include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidential juvenile court records. If any, cannot be included in this response. A signed release authorization is not sufficient to obtain this information from the Division of Criminal Investigation. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry: http://www.iowaaexotfender.com/ . However, even though some information is available on this site, the actual records for Juveniles may still be confidentlal and any confidential juvenile records cannot be provided with this record. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(16). IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD I$ BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS TRB SUBJECT OF YOUR INQUIRY. Feb.19.2021 12:31FM ON IOWA N0.5011 P. 3/3 DIVISION OF CRIMINAL INVESTIGATION F17 2 i 2021 iovve C'�.; �AO I A D OT www iowadot: ov SMARTER I SIMPLER I CUSTOMER DRIVEN g DMM d waMrfeatlon SMlM PO Box 9201 I Des Moines. IA 5030&S M Phone- 51'5-244-91241 FaX 515-2591897 Certified Abstract of Driving Record Inquiry Data: 2/19/2021 DL/ID #: 959ZZ4167(IA) Customer #: 471063 Name: Worden, Brian Class: A ID Status: None Thomas Address: 2552 PUTNAM ST Audit #: 3254555 DL Status: VAL NE City/State: IOWA CITY, IA 522407706 Mailing Address: 2552 PUTNAM ST NE Mallin IOWA CITY, IA City/State: 522407706 Issue Date: 10/02/2018 CDL Status: VAL Expiration Date: 08/21/2023 CDL Cert Status: Excepted Intrastate Endorsements: Motorcycle CDL Med Status: None Restrictions: CDL Intrastate Only Restriction None Supplement: Date of Birth: 08/21/1976 Sex: M History Information CLEAR DRIVING RECORD Name: Worden, Brian Thomas DL/ID: 959ZZ4167 F13 21 1011 City Clerk Iowa City, Iowa 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. 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: Warden, Brian Thomas DL/ID: 959ZZ4167 2/19/2021 Driver & Identification Services Iowa Department of Transporation