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HomeMy WebLinkAbout15-096� r �. Nlrumi®�i CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ IDENTIFICATION NO. �� Q (Office Use Only) APPLICATION FOR TAXICAB I 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 T 2. Address (REQUIRED) 2,? -14o n13 ST �]C df� �Lt%1�y� �� S z2l / 3. Contact Information (REQUIRED) Email: H\ p{�(y'1 0 0-,c AjCell Phone:_7-11 (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) © 1 o t b. Taxicab Business Name (REQUIRED) _ l �c iv — e 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? ly <z) TVl of offense What happened to the charge? (Circle one) Where Convicted Dismissed Deferred Suspended Plead Guilty 7. Have you been arrested / charged with any traffic offenses in the last five years? I ;M.>t + r I=,r p .. Type 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? fir n 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) 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) 02,'2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 2iq -,( � 9 2.3 issued ono expiring on Pilmlol I �. I understand that if I falsely answer any questions in this application, that this app ica ion 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 of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) i Signature of Applicant Date o —0/Zr- STATE 0 STATE OF IOWA ) COUNTY OF JOHNSON ) StAscribed and sworn to before me by Vbv�'��r ��r 5 on this � �� 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 (Title 5, Chapter 2, City Code). Expiration date of Chauffeur's license I It 11-0(l (l Signatu rvllice 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. i?�71-1e c ' - - � / & . �' AA Signature of City Clerk or designee t/.�/s Date GIerWT IDRIVDADGEAPPL92014amended.DOG 03/2015 Office Use Only p _o `^ Approved application yc y o r" DCI report ;<r` M State certified driving record Q-0 Website update GIerWT IDRIVDADGEAPPL92014amended.DOG 03/2015 Apr.17. 2015 3 � 4 7 P M Div of Criminal Investigation No,5280 P, 6/6 F r —,y -. . - v_ —,y Ci orn vinic oro soon. d. 0a/76/2016 16:3U w032 5.002/002 STATE OF IOWA iF' Crio> foal History Record Check _, Request ]Foran. To; Iowa Division of Criminal Investigation Support Operations Bureau, V Floor 215 E. 7" Street Des Moines, Iowa 50319 (515)725-6066 (515)725-6000 Fax I am reauestina an Iowa Criminal History Record Check on! DCI Account Number: Li o b �- r (ifepplicable) From; City of rows City City Clerk's Office 410 E. Washington Street Iowa City, IA 52240 Phone: 319356-5041 Fax: 319-356-5497 Last Name (manda(ory) First Name (mandatory) Middle Name (recommondcd) 11)R15 099w3_ _ Date of Birth (mandatory) Gender (mandatory) Soc++ia,�l Securi Number recommended) C5 I As I/ `7 2 dMale OFemale A/elver Information, Without a signed waiver from the subject of (he request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692,2, For compteta criminal history record information, as allowed bylaw, always obtain a waiver signature from the subject of the re nest. Waiver )lelease:1 hereby give pern7issian for the above reguesling official to wnduct an Iowa criminal history record check vrith the Division of Criminal Investigation (DCD. Any edmiml history data wncemingme (halt is maintaincd by the DCI maybe released as allowed by law. ' L Waiver, Waiver Signature: """' • \ Iowa I Criminal Histor Recolyd Check Results (DCI use anty) As of \J, 1) a search of the provided name and date of birth revealed; No Iowa Criminal History Record found with DCI r is rTl CS Cs— C7 Iowa Criminal History Record attached, DCI DCI initials•��^ r' N DCI -77 (09/25/10) Received Time Apr.16. 2015 3:24PM No 5659 CIowa Department of Transportation AO r Oce d Driver Services (Tots Musa 80E4 8.1121 PO Snit 9204, Des Caortes, IA W30"204 515-24+4-9124 FAX 515.2391837 CLEAR DRIVING RECORD Name: Idris, Abubakr A DL/ID: 239CC5823 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: 4/29/2015 IOWA sY d f3. {t. T �{iyy Office of Driver Services wrap^ Iowa Department of Transporation Name: Idris, Abubakr A DL/ID: 239CC5823 Certified Abstract of Driving Record Inquiry Date: 4/29/2015 DL/ID #: 239CC5823 (IA) Customer #: 2657219 Name: Idris, Abubakr A Class: D ID Status: None Address: 2240 13TH ST Audit #: 7359138 DL Status: VAL Issue Date: 09/19/2013 COL Status: None City/State: CORALVILLE, IA Expiration Date: 01/01/2016 CDL Cert Status: None 522411372 Endorsements: 3 CDL Med Status: None Mailing Address: 2240 13TH ST Restrictions: NONE Restriction None Supplement: Date of Birth: 1/1/1972 Mailing CORALVILLE, IA Sex: M City/State: 522411372 History Information CLEAR DRIVING RECORD Name: Idris, Abubakr A DL/ID: 239CC5823 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: 4/29/2015 IOWA sY d f3. {t. T �{iyy Office of Driver Services wrap^ Iowa Department of Transporation Name: Idris, Abubakr A DL/ID: 239CC5823