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Home My WebLink About15-002r'Ifl z •` �` SIM®Ii mt.as._ 14 CITY OF IOWA CITY 410 Cast Washington Street Iowa City,llo_wa 52240-1826 (319) 356 _504t� (319) 3S6-5497 FAX Authorization Number I �;-- � _ (Office Use Only) { 0,v\ APPLICATION FOR TAXI I MOTORIZED PEDICAt3 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 Middle 1. Name (REQUIRED) 2. Mailing Address (REQUIRED) 3. Contact Information (REQUIRED) Email: aw fl �a�;f .4—Cell Phone: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol ordrugs in_the last fve years? M ., Tvpe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 0 Tvpe of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? NO 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) 09/2014 I hereby certit at��ave issued to me by the Iowa Department of Transportation a valid Chauffeur's license number, I understand that if I falsely answer any questions in this application, that this � application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will 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 a license 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 V4110 Date A/-7-6 t YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by �" t^R �� s ., is w On this S day of No ublic and for the State of Iowa �3in 1 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 P li e,F' ief or d signee /- 5 Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. _2el-^ v�! Sign ture of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 W1 (width) and 5 %11 (height) and prominently displayed to all passengers. ydJ Office Use Only Approved,`jjlication-. DCI report State certified drivin�Precord` Website update f_-� CierWIAxIDRIVBADGEAPPL92014amendedDOC 09/2014 Jan. 2 261 116:15Ai�q ra Dlvof Crlr,inaI Investigations STA 1E E OF IOWA tC>rftn2naa IH [story Record (Check Request Form— To: Iowa Division ofCrfmival )nvestigatlon Support Operations linreau, 1'1 Floor 215 E. 7'" s^f reet 1aeY 1Vloiues, XoW4 50319 (5f 5) 7219-6066 (515)725.6000 Pax 1 a,r .n Tnwa 0xim in of Fliat.)ry Record C11eok on: No. 7232 P. 1/1 �. v. � ..1 L, L DCI AccountNanabot: (lrappllcuble) From: City of Sowa CI4y _ City Cleries Office 410 E. Washinp4on Street Iowa City, T.d, 52240 )'hone: 319-3S6-5041 Fax; 319-356-9497 Lase Name (mandatory First NAM (mandatory) Diddle PtaTate recommulded) Na�'�t� :JM,10I ( ��j),1�„� Date ot'$Iitll (mandatary) G®rider (m5nde(ory) 9JNIale ❑Female g'ocial 4eCllri Number recommended) 360- qq- 0 Orb l4Z I�i�O waivep lltropmwioyl without a signed waiver from tha subject of the request, a complete criminal hlsfory record may not be releasAbla, per Code of Ioiva, Chapter 692,2, )For complete criminal history record information, as allowed by law, alWays Ohio Ina waiversl naturefromthesubectofthere nest. Waiver Rele2Se! I hereby give pemilssion for Ilse eboVa lequufing off cisl to conduct an Iowa criminal hluory rewrd check wi th the Mfelon otCelminal laveyllgedon(M). Any criminal history dais concwningpl th t1:Vstnmined by lho l)CI may 6e rebated ea allowed by law, �ltiYEp.iigJ2Ri!lp2: orwa �riniinal Histolr Record (C heck Re iti (nely„only) As of�2% /.'> J a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with .DCI ® Iowa Criminal History Record attached, DCI # IDCIin10ss 2/ Received Time—De c. 31. —2014-11:04AM—No,7177 I1r1T.77 (npiavi0) Page 1 of 1 W A "NOWADOT :AIARTER SiriiFi,El{ " :1�?fvl '. G.RkiIEN °dsPVd�l ,i[1:,,1c �t ? iClsr Office of Driver Services PO P.'3z 2204 1 Des fiomes,:A 50s 13-9204 Pn•7i__ 15.-244-9124 1.8VO 5.3e-i'2I [Fa,,: 515 23•a-Vv37 A WSY_i'Ywaw:x gJV Certified Abstract of Driving Record Inquiry Date: 12/31/2014 DL/ID #: 732AJ6748(IA) Customer #: 6138609 Name: Ismail, Ahmed Hassan Class: D ID Status: None Address: 2363 WHISPERING Audit #: 8729082 DL Status: VAL MEADOW DR Issue Date: 12/31/2014 CDL Status: None City/State: IOWA CITY, ]A Expiration 05/02/2016 CDL Cert None 522406806 Date: Status: Endorsements: 3 CDL Med hone Status: Mailing Address: 2363 WHISPERING Restrictions: NONE Restriction None MEADOW DR Date of Birth: 8/2/1970 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522406806 History Information CLEAR DRIVING RECORD Name: Ismail, Ahmed Hassan DL/ID: 732AJ6748 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: '•7f794�� 12/51/2014 IOWA :a-, D. D. T.:f" es F BRIVER SE� Office of Driver Services `x18010 Iowa Department of Transportation Name: Ismail, Ahmed Hassan DL/ID: 732AJ6748 12/31/2014