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Home My WebLink About15-111IIIPUMA A Ill cccccill MIyI®r®�\ CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO IS -1!I (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 2. Address (REQUIRED) `f oi�CjI 3. Contact Information (REQUIRED) Email: 4a. Chauffeur's License expiration date (R b. Taxicab Business Name (REQUIRED) Last C(`f0G,LA9,t?bf 5'5-3V 'Vcf'20' Cell Phone: written communication sent via email) 5. Prior experience in transportation of passengers: 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 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? AJO) Type of offense Where When 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? Type of offense Where )iAn�-- M M M -v What happened to the charge? (Circle one) CO Q Convicted Dismissed Deferred Suspended Plead Guilty OtheLn 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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 ,Q -7/, 11 issued onoE-2o-I5 expiring on )�;,- 0�2. 1 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 provisions of Title ?, CMSter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant ,;F{ .{ Date dit, 2— YYENDY S. STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by R E -C Smt) s.c 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 JOlh -L' L/1, Signature of Police hf or designee C�,(WC-5 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. Signature of City Clerk or designee �/, A )is Date Office Use Only o Approved application 4 �^ ate DCI report C10 hl State certified driving record -`-ice � Website update _r Y� Zc w !U Cn ClerkfTA IDRNBADGEAPPL92014amendM DOC 0312015 MaY.21. 2015 11:32AM D l v u Criminal Investigation No8643 K 1/4 F mIz C.IP/ Ot to W& Cris, CIeek Otrle& 316 96664®Y []5/20/201E }6;6E x070 P.002/002 STATE OF IOWA " Criminal History Record Check 1 • Request Forrin To; low'e Division of Critainal Investigation Support Operalions Bureau, 1'I Moor 215 F., 711i Street Des Mo)nes, fovea 50319 (515) 725-6066 (515) 725-6000 Fax I am requesting an 101AIn Criminal f-listrnv Remrel Check nn• DCI Accouui Number: G-/ 0t7.p r (if applicable) From: Ct cfl0waCid City Clerk's Office 4101;. V✓ashingtan •4treat lova Cit, IA 52240 Phone: 319-356-5041 pax: 319-356-5497 Last Name nnandatoq') First Name t,nandaan•) Middle Name (reeommended) C s f I Date of Birt11 (mandatory) Gender (mandator) Social Security Number (reeomma,ded) c� As of_- �--Z�_ a search of the provided name and date of birth revealed: d8-(6477 WilIVel'l"forr17ati011r Without a signed waiver A-om thesubject of the request, a complete criminal history record may not be releasable, pe: Code of Iowa, Chapter 692.2, For complete criminal history record information, as allowed by law, always Main a waiver si mature fram the subject of the request. Waiver Release, 1 hereby give permission far We abov, requcsling official to candun an few& criminal hiaory rcoord check wisp the Division of Criminal In Agoation (DCI). Any criminal history data conceroing me that is mains hied by the DCl may be released as allowed by taw. WidverSip? (iture: Iowa Criminal Iiistor li2ecol tl Cit clz Results (Dc, usey,y) _ c� As of_- �--Z�_ a search of the provided name and date of birth revealed: - cn Into Iowa 12nminal History Rccord found with DC:I 2:,. N Q � 70':) lovva Cl'1n11nal HisLor)' Record attached, DC1 ii w DO nutlals_h161 -_ J I)CI-77 (08/25/10) Received Time May. 90. 2015 2:49PM No. 85111 Page 1 of 1 iNvAv,iowadot.gov 51ANER I cI"?FL F i CUSTO'r,=R DRIVE'J��.��,,.........:. Office of Driver Services PO Box 9204 Des Moines. 64 50306-4204 Phore_515-244-91241800-532-1121 1 Fax: 515-239-1837 wwa.iowadot.gov Certified Abstract of Driving Record Inquiry Date: 5/20/2015 DL/ID #: 876AL6088 (IA) Name: Gasmelseed, Emadeldin Class: D Status: Abdelrahman Khali Restriction Address: 910 BENTON DR APT 32 Audit #: 9100732 Issue Date: 05/20/2015 City/State: IOWA CITY, IA Expiration 08/16/2022 522465227 Date: Endorsements: 3 Mailing Address: 910 BENTON DR APT 32 Restrictions: Corrective Lenses Date of Birth: 8/16/1978 Mailing City/State: IOWA CITY, IA Sex: M 522465227 History Information CLEAR DRIVING RECORD Name: Gasmelseed, Emadeldin Abdelrahman Khali DL/ID: 876AL6088 Customer #: 6311737 ID Status: None DL Status: VAL CDL Status: None CDL Cert None Status: atoviic�$ CDL Med None Status: Office of Driver Services Restriction None Supplement: 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: t.......qr`ill, 5/20/2015 iowa'':s . fl, D. 0. T.;e=4-V atoviic�$ I BB111fa Office of Driver Services Iowa Department of Transportation Name: Gasmelseed, Emadeldin Abdelrahman Khali Dli 876AL6088 5/20/2015