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Home My WebLink About15-112First Middle Last 1. Name(REQUIRED) an A) AUln 4AI-.k 2. Mailing Address (REQUIRED) '2.52 0AgtGir Rd1 APt Cfb t&UkAA IAS'L24L 3. Contact Information (REQUIRED) Email: Phone: 7m3 200-•'� a �( E, 4. Prior experience in transportation of passengers: 0,Wf yrLa 4!/M U Ur CMA l Oui(l c -cam 5, Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where tJ c' 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? V6 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When a_ Has your drivers license or chauffeur's license been suspended or revoked in the last five years? 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 ame(s) h!e' DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE eudIFIFD DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHf$FREVIEW You must apply for an Individual Department of Criminal Investigation Report (form availagle'upon=requetst):I (OVER FOR REQUIRED SIGNATURE AND NOTARY) co 09/2014 Authorization Number Only) (Office Use C A, CITY OF IOWA CITY APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 6 a.m. to 3 p.m., Monday — Friday.) 410 East Washington Street Iowa city. Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (3 19) 356-5040 (3 19) 356-5497 FAX First Middle Last 1. Name(REQUIRED) an A) AUln 4AI-.k 2. Mailing Address (REQUIRED) '2.52 0AgtGir Rd1 APt Cfb t&UkAA IAS'L24L 3. Contact Information (REQUIRED) Email: Phone: 7m3 200-•'� a �( E, 4. Prior experience in transportation of passengers: 0,Wf yrLa 4!/M U Ur CMA l Oui(l c -cam 5, Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where tJ c' 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? V6 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When a_ Has your drivers license or chauffeur's license been suspended or revoked in the last five years? N� Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the ame(s) h!e' DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE eudIFIFD DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHf$FREVIEW You must apply for an Individual Department of Criminal Investigation Report (form availagle'upon=requetst):I (OVER FOR REQUIRED SIGNATURE AND NOTARY) co 09/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 59 (. A N a5-gf cT . 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, 1 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 0 Date 2 — Z— of ; YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERKS OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn t before me by y l do n Al cc Rct i On this Q day of 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). Yv Ml Signature 7TVALITO ief or designee D to YOU ARE DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERKS OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Signature of City Clerk or designee Z/3 /i s T Die Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/a" (width) and 5 Y=" (height) and prominently displayed to all passengers. Office Use Only Approved application DCl report State certified driving record Website update CIe,k1 MDRN GEAPPMDI4.WW.DOC 092014 J1UI ff ..! SMARTER I SIMPLER I Page 1 of 2 '11Vww Iowadb} htiv, PO Box 92041 Des 14 Phone: 515-2449124 f WD -532-1121 Certified Abstract of Driving Record Inquiry Date: 1/28/2015 DL/ID #: 596AH4569 (IA) Customer #: 595549B Name: Algaall, Bahaeldin Class: D ID Status: None Akasha Address: 2525 BARTELT RD APT Audit #: 6994684 DL Status: VAL 1A Issue Date: 05/31/2013 CDL Status: None City/State: IOWA CITY, IA Expiration 10/23/2017 CDL Cert None 522462718 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2525 BARTELT RD APT Restrictions: NONE Rastrictlon None IA Date of girth: 10/23/1973 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522462718 History Information Accidents - Accident involvement Indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number v..__....�.»_ 3118 01/22/2014 w�i761326 JIA Name: Algaall, Bahaeldin Akasha DL/ID: 596AH4569 Pursuant to Iowa Code §321.10, T, 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 allthOriZetl 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,_�t Ankeny, Iowa this date: o .;f!r 1/28/2015 r' W D O. Office of Driver Services Iowa Department of Transportation Name: Algaall, Bahaeldin Akasha DL/ID: 596AH4569 1/28/2015 Jin. 29. 2615, 1: 12Ph� )an. M Lt119 11MI Div of Criminal Investigation bl t 6 1 e r K — bl 1 of 10Wa LIIy STATE OFIOWA Criminal Higtayy Record (Check Requuvgtt Form To, Iowa Dlvhlon of Crimlaal hlvestlgatfon support Operations Durepla" tFloor 215 E. 71h skseet DesMohles,lown $0319 (515) 725.6066 (813)125•do®o Bag No. 9176 P. 1/1 Ito, 7 ) N. L DCT AccountNulnbov; nC)2-eF Ofepplleahle) Rom: Cltyoflowacity City Cleric's Zell 410$,Washln Zell IowaCl!b IA 52240 Phone: 319-356-5041 •Banc: 319-9565497 iaetNamO mends! ]FiretName (mandoo ) 141tddleldame etonlmendea gaayalu 13P(4A( L)1A1 A0514AAHM D Date Of Dirih menemb condor (mandatory) 5"ocial security Number reeemmalded witiver.Th(fof mallow without aligned waiver ftm the subject of the, rdquest, a complete, criminal history record may not be releasablo, per Code oflowa, Chapter 692.2. Porgomplets criminal history record Illfdrmetlon, AT allowed by lave always Main a waiverst nature from the sub ectofthei uesf. 1{raiverIterease. lhcrchy give pennuFlon fortre above leVonin6 omailto comucten Yon. criminal h4mryrceard ehwk with du DNislon ofCrlmlael Ynvrsdsadoe UICA. My erlminel hhterydata wnMOIIIrile theta meletelned by iho DClroeybe released ae allowcd by Inv. Waiver Signature: gowa {;riming i t2ry Rgeord Check ]results teuanly) rn ) II 77 — As of 6 tr�- �� a seatoh of thoprovldedname and date of bhthrevealed: ; ;o ca No Iowa CliminallTlslory Record tbund with DCI c� low&. Crimind ffistozy Record attwhcd, DCI # DCI3aidals Kw Received T,ime;�Jan,,•26; ��014�11:53AhrRo,