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HomeMy WebLinkAbout15-064CITY OF IOWA CITY 410 East Washington Strcet Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. ! C�4 (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 First I 1. Name(REQUIRED) _ 5c� UJIi cjX UJ/ 2. Address (REQUIRED) h+r,5�Q r-16 Szz4n 3. Contact Information (REQUIRED) Email: Cell Phone: 2-0z tp IS 13-f-6 (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) cs 4 - 1-1 _ 2al g b. Taxicab Business Name (REQUIRED) T'a--o-r'1 1 nX 5. Prior experience in transportation of passengers: 3 Y e.\I- S 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? NES Type of offense Where When Whathappened 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? lir^ Tvpe 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? Imo/` (7) Tvpe 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) (V 0-) 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby cert, that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number (� j �1 rjC�o issued on -i,,rexpiring oner I understand that if I falsely answer any questions in this application, that this application may be denied. 1 agthat in making this application, 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) Signature of Applicant \ Date o 3_ �S, Lel s STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by�-s ra Cr I) lc; rye e , on this / fi gday of MM<k� Zdtj n n S, "AV R.10- __! Notary Public in and(fcTr the State of I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). Signatu ofPol� Piel 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. THE EFFECTIVE DATE WILL MATCH THE CHAUFFEUR'S LICENSE EXPIRATION IF LESS THAN A YEAR. Sight, tureo CityClerrdesignee Office Use Only Approved application DCI report State certified driving record Website update MAI 1 8 2015 ClSrk T AIORIVBADGEAPPL82014aneridedDOC 02/2015 Mar. 2. 2015 4:12P ^ Div of CrlrninaI Investigahon1l No. 1480 P. 1/6 rr. t Gv .� Iv. V1 LY UI lUna L1 lI Vul r. STATE OF 1OVVA CruMiDial)F$>AORI Recoyd Check Request Form � To: Iowa Division of Criminal Investigation Support Op erotions H ureau, l" Floor 215 F. 7ih Street Des Moines, Iowa 50319 (515)725-6066 (51S) 725-6080 Fax as Iowa © 4-rz, I� 63 Record Mrsti DCl Account ldumber: G/Gp -1''F� (if Applicable) ftoml Oty of Iowa cit City Clerlc's Office 410 E, Washington Street Iowa City, IA. 52240 Phone; 319-356-5041 Irax: 319,396-5497 f�sr-.d S man Mcmale I �'F s 6 g 4 S Waiver bVormalikon. Without a bfghed waver from the sabiect of the request, a complete criminal history record may not be reTessable, per Code of Iowa, Chapter 692.2. For cornl2lo criminal history rocord Informatfon, as allowed by law, always ohtabt a walversignafure frorn tha snhlect of the renuest. Waiver ReCeose:Ihereby givo pernusaloa for lho obovo rcqueslingem Ito whducl ea Iown erlminal bfalorymwrd check with Iho D{vision of Criminal Investigatfoo(DCI). Any alminel hisiory data col h 1 1 Mal a the DCrmayhareleased uaallo%M bylaw. Witiversignatare: Iowa Criminal History Record Check Results, (DCluse 01„y) As of 3 a 1 kk�- a search of the provided name and date of birth revealed: No Iowa Criminal history Record found with DCI ® Iowa Criminal I-Tistoxy Record attached, DCI # r_ DGEinitials �.. Ti77 nCNc1l0% Received lie (e b. 27. 2015 10:51AM No. 1344 ;0iUWA00T I;TF,s f ttv3NrF i'. JC?.":aEfir°=;4i?IsiF�;. O11ACe of Driver Services.. Pit Err< L9204: C1r_.5 Moines IA `_0306-5201 P:h ea_ 515-244-14124 P F.'0i,_d32 1121 I Fa .,1c-230-13.1.7 wVrm, iowadoEge") Certified Abstract of Driving Record Inquiry Date: 3/18/2015 DL/ID #: 669AJ7600 (IA) Customer #: 6063944 Name: Makawi, Asaad Suliman Class: D ID Status: None Address: 2507 WHISPERING Audit #: 6807976 DL Status: VAL PRAIRIE AVE Issue Date: 03/26/2013 CDL Status: None City/State: IOWA CITY, IA Expiration 04/12/2018 CDL Cert None 522406725 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2507 WHISPERING Restrictions: NONE Restriction None PRAIRIE AVE Date of Birth: 4/12/1963 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522406725 History Information Convictions Gitz3t€o" Drit� c=owviu"ltor. Date ACD Explanation Countp 3U€8 10/27/2013 03/12/2014 �M 14 }Fail to Obey Traffic Sign/Signal _ _.. Johnson IA 12/21/2013 .01/21/2014 M 1 4 Fail to Obey Traffic Sign/Signal :Johnson IA Name: Makawi, Asaad Suliman DL/ID: 569A]7600 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Office of Driver 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: ? '•:�/��rrr 3/18/2015 IOWA D. 0. T.•:� i �FORIVENg Office of Driver Services Iowa Department of Transportation Name: Makawi, Asaad Suliman DL/ID: 669A]7600