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Home My WebLink About15-093�III�13 CITY OF COWA CITY 410 East Washington Strect Iowa City, Iowa 52240-1526 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO 5'r) q2; (Office Use Only) APPLICATION FOR TAXICAB I MOTORIZED PEDICAR 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 3. Contact Information (REQUIRED) Email. 5 `�GCOL �✓(�C(h ,�lx�IlPhone: ��q/p f� /0rfL/_ (A( written co(mjmunicat ss�e/t via email) 4a. Chauffeur's License expiration date (REQUIRED)/ _ /(�j pZ/ j3 3 b, Taxicab Business Name (REQUIRED) If/ ( % 16 —L C�^/ 5. Prior experience in transportation of passengers: � 9,01 //. i .7L 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When ! WLp%P What happened 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? What happened to the charge? (Circle one) J Convicted j Dismissed Deferred Suspended Plead Guilty Other S. Has your driver's license or chauufffeeur's license been suspended or revoked in the last five years? Type of offense Where When ru q 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pro tat The IWame(s� /1 \ —rc� ,.r DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE 4WTiFi DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE Cf*EF REO[ W rn You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2075 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I h!zcerti at � have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number Vii ( j ) issued on 12 �2 expiring on 12, 3, Ij . I understand that if I 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 provision, of Title 5jC „ h ter, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant ` _-k U �� 9 Date -2f, ° kkhk#########**####*#***###**##****************Fk*#kk*k*hh#####**##*##k*k#k##**#****#**##***#************Fkkkk#h#########*>#**#***#** #**#****### STATE OF IOWA ) COUNTY OF JOHNSON ) Skbscribed and sworn to before me by S on this rD:A�� day of in and ***Fhh**#***h#x**rt**#***********#*#*******#**************az**kkkkh#h***###*#**#*#k*kkh**A***#*#**********************Fk FFh##*#vk**#************** 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). Sign lure f 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. THE EFFECTIVE DATE WILL MATCH THE CHAUFFEUR'S LICENSE EXPIRATION IF LESS THAN A YEAR. 11rrc SignatbTe of City or designee 7 /1s Date N Q Office Use OnlyCy Ut o _ 2 Approved application �� -n M DCI report M 3: State certified driving record — Website update 3 N aFrkITAXIDRIVRADGEAPPL52014...ndedDOC 02(2015 Iowa Department of Transportation 00ce d Dmw Serom (Tdt Free) 80R 532-1421 PO Eft 92Q4, Dog Molttsa, 1A 503M 9204 515-244-9424 FAIL' 515-239-1'.83 T Certified Abstract of Driving Record Inquiry Date: 4/14/2015 DL/ID #: 830YY1331(IA) Customer #: 212457 Name: Alawneh, Pamela Class: D ID Status: None Sue Address: 1453 DICKENSON Audit #: 6527012 DL Status: VAL LN Issue Date: 12/07/2012 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 12/03/2017 CDL Cert Status: None 522409163 Endorsements: 3 CDL Med Status: None Mailing Address: 1453 DICKENSON Restrictions: NONE Restriction None LN Supplement: Date of Birth: 12/3/1967 Mailing IOWA CITY, IA Sex: F City/State: 522409163 History Information Convictions Citation Date Conviction Date ACD Ex lanation iCounty JUR 01/24/2011 102/17/2011 S93 Seed Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 01/24/2011 614926 IA 07/30/2013 750711 IA 11/11/2014 826535 IA Name: Alawneh, Pamela Sue DL/ID: 830YY1331 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: FvF 4/14/2015 IOWA o D . 0. T •Ara Office of Driver Services Iowa Department of Transporation Name: Alawneh, Pamela Sue DL/ID: 830YY1331 Fe b. 25.'2615 9:19AV, Div of Criminal Investi;ation .[1. (u IJ IV. IInl" �I L yICIK <,11y UI 10Wa k,I t STATE (EDF IOWA ,yd Check 4 „ A h� ., � i I. I Form' i To; Iowa Dlvlslon of Criminal Investigation Support operations Bureau, I° Flool• 215 E. 7j" Stfoot Des Moines, Iowa 50319 (515) 721-6066 (515) 725-6090 Fax I am re uestir Lest Name w I�t - 6, i (mandelary) i Gadder fnimdalelvl Nc.1636 P. 3 NO. )Doi P. i DC1 Account Nunlller: �,P -F (ifappllaeble) From; Clty of Iowa City City Cleric's Office 410 T, Washington Street Iowa Citv. 1A 52240 Phone; 319-356-5041 Fax: 319-356-5497 S u-2 Social Security Numbek Waiver Zr ormaiion: Without a signed waiver ll'om the subject of the request, a completo criminal history record may not be releasable, per Code of Iowa, Chapter 692,2. For c m fete Criminal history record informallon, as allowed by law, always ohtain a %VAIVAr siomfurP fl -nm fhn elr6G<eF nirihn vnnuoo4 Waiver Release; l h by gry puniTl31IY8rd1 bovc regnrsling o0101e1 to unductm Lown criminal hisferymcord dlakwllh the Division ofUminsl Drvuligalion (OCT). A,ly ctiminal isfory dela GoouGlingn lhsl lsmeinla' y eDCl may be rolee9ed ds allowed by law. waiver siglIale . (gyp y,b Iowa Criminal History Reco deck ides (DCl nse ani» As of Z 2� V,) . a search of the provided name and date of birth revealed: ® No Iowa Criminal History Record found with DCI Iowa Criminal history Record attached, D CI # 131-1 2V-1 DCTinitials � � - r e7 inanrn0N Received ice Feb, 24. -2015 10:42AM No. D956 Fe'o.25, 2015 9:19AM Div of Criminal Investigation No. 1636 P. 4 DCI;00517224 NAME; GILPIN,PAM OILPIN,PAMELA SUE DOS SEX RAC 19671203 F W ADDITIONAL IDRNTIFSERS IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY HGT WGT 506 130 CCH RECORD *" DCI 00517224 PAGE I OF I DATE PRINTED - 2015/02/25 EYE HAIR SKN POB BRO BLN FAR IA 01 ARRESTED 19960211 AGENCY: IAOS60000 LEE CO SO CHARGE NO- 02 IA STATUTE IA706-1 ASSAULT TRK#: 013605402 COURT DISPOSITION AGENCY: IA056015J LER CO ni ST COURT COUNT NO- 02 TA STATUTE- IA700-2i2j ASSAULT NO INTENT OF INJURY CHARGE CLASS: MISDEMEANOR CONVICTION TRK4; 013605402 SENTENCE DISP EFF DAT SAIL 30D 19960514 FIND $250 19960514 COURT COSTS 19960514 PROBATION lY 19960514 CREDIT W/TIME SRRVRD 19960514 NO CONTACT ORDER 199605/4 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED HY 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 DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR IN=RY. DIVISION OF CRIMINAL XNVESTTGATION L,`l Feb. 25, 2015 9I)AM Div of C r l m i n a I Investigationd I v -4-h z 11 1v. RYrnn CI k V VIN b L J I Nd VI t! uF u� STAT9 OV t a �J• IpiyA `I ICriminal Historcy Record Check FI, Request Form To: Iowa ]Division of Criminal Inveailgatton Support Operailous bureau, 1`I Floor 215 E. Te, Street Des Maines, Iowa 50319 (515) 725-6066 (515) 925-6000 Fax I am remae5tinrr an Tnwa Criminal Hiatoty Rocorel Check rn - Nuowu)6 PF. z5 DCI Account Number, y�.-, (irappllceW) From. City oflowa City City CIerIPa Mee 410 X Washington Street Iowa City, IA, $2240 Phone; 319-356.5041 Fax: 319-356-5497 Last Name (Inandaiory) F1rst Name mandatory) Middle Name rernMmalee �' �I � �Pa.�,�e.� " •�� Sue. Date ofBirth (mamatory) Gender mandate, Social Security Number(Fewt[mended a 3I �P� ❑Male Female�� Waiver Warmativii. Without a signed waiver from ilia subject of tho request, a complete criminot history record may not be releasable, per Code of Iowa, Chapter 692.2. $or tompleto criminal history record Information, as allowed by law, always obtain a waiver al attire from the subject of the request. Waiver Release;lherebygivepmrds' tth verequesfingoflelalt000advetanIowacrlminethlstory mold checkwilhthoMtsionofCrownai fawstigellhn CDC]). Mycrlminel history ole opncemingmet is mainsaincdb .e m released of dletrcd bylaw. Waiver Signature: e� • ^ a Iowa Criminal History Record Check Results (L)CI 11500hIQ) As of 2`I'D--(63 , a search of the provided name, and date of bh1h revealed; 0 No Iowa Criminal history Record found with DCI tRIowa Criminal f-EstoryR,ecord attached, DCT # bCI initials�� Received TimelFeb,'24.02015 10:42AM No. 0956 L'\ Fe 9. 2'a.• 2015 9:19AM DCI :0051'1224 NAME- GILPIN,PAM GILPIN,PAMBLA SUE DOB SEX RAC 19671203 F W ADDITIONAL IDENTIFIERS Div o' Crlin lnaI I n v e s f l g a t l 0 n IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI 00517224 PAGE 1 OF I DATE PRINTED - 2015/02/25 HST WGT EYE HAIR SKN POB 506 130 SRO 13 LIN FAR IA CCH RECORD *" U1 ARRESTED 19960211 AGENCY: IA0560000 LEE CO SO CHARGE NO- 02 IA STATUTE IA708-1 ASSAULT TRK#: 013605402 COURT DISPOSITION AGENCY: IA056015J LEE CO DIST COURT COUNT NO- 02 IA STATUTE: IA708-2(2) ASSAULT NO INTENT OF INJURY CHARGE CLASS: MISDEMEANOR CONVICTION TRK14 : 01,3605402 SENTENCE DISP EFF DAT JAIL 30D 19960514 FINE $250 19960514 COURT COSTS 19960514 VROGATION lY 19960514 CREDIT W/TIME SERVED 19960514 NO CONTACT ORDER 19960514 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 EUPORCEMEN'T AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No. 1636 P. 6