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Home My WebLink About15-129IDENTIFICATION NO. —/5-- )a 9 l 1 (Office Use Only) APPLICATION FOR TAXICAB 1 MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) 410 Last Washington Strcct Iowa City, Iowa 52240- 1 826 Failure to complete the "required" information will result in denial of the application (3 19) 356-5040 (319)356-5497 FAX First Middle Last 1. Name (REQUIRED).. R 4.. A �A',J L�� \e'� 2. Address (REQUIRED) \x.53 �'..C'Fe lSu^ Ls^j �.3vJN <�Y ,Lps�Zr2"\� 3. Contact Information (REQUIRED) Email: K0.kZc Y \2p �yL�� "LAN Cell Phone: �\Cj -moi U� _ ( c3 (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) Ck - 4 b. Taxicab Business Name (REQUIRED) 4- 'I- C 1-3 LC,: 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? Y- s Type of``o__ffense Where When 4 See sack �k- What happened to the charge? (Circle one) Convicted Dismissed Deferred SuspendPlead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years. 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? r 1 O 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) ru _ o b cn DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATTIWKD DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE C%7 -+C RI�tIEW „ N g� You must apply for an individual Department of Criminal Investigation Report (form avai-*M%uprN regdest).-� b M (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARNia o cii 02/2015 R? 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 <t A t issued on �f: - VL expiring on 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 provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant_..__. t ' ' Date STATE OF IOWA ) COUNTY OF JOHNSON 1 Sub�ibed and sworn to before me by 12,0 r-- t- A- • e- on this X29 day of ,r— 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 09j,()(,0 jlov r Signature of Police Chief or designee 23 Is - 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. r - A�� 216n lure of City Clerk or designee 1'�-q S D to N 0 Office Use Only Approved application h - Z CNa DCI report State certified driving record C3 s Website update cn No CleMTMORNBANFAPPL92014amended.DOG 0312015 un. 1. 2U1� 4;J2NM Uiv of Criminal investigation No. 9616 P. 6 , _. ---w_ ,, clerk ......,, ,.._ ,,--.._,,. 06/01/2016 11:2- -J97 .._02/002 ' STATE OF IOWA Criminal History Recoyd Cheek; Request Form 'rot Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 C. 7"' Street Des Moines, Iowa 50319 (515) 725-6066 (515)725.6000 Fax I am reuuestini[ an Iowa Criminal History Record Check on - DCI Account Number: 110o �. (itapplicahle) From: City of Iowa City City Clerk's Office 410 F., Washington Street town City, iA 52240 Phone: 319-356.5041 Ira r: 319-356-5497 NTame (mandatory) First Name (mandatory) Middle Name (recommended) LA �A t�� Date of Birth (niandao) Gender (mandatory) Social Security Number (recomrnendM) "` �' a �� Male ❑Female �� S �-- 6� `'� 2 Waiver Information: Without a signed waiver from the subject of the request, a complete ci ilninal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record Information, as allowed by law, always obtain a waiver sin -nature from the sub ect of the request. Waiver RElease; (hereby give permission for the above requesting otneioI to conduct an Imen criminal history record cheek +rich the Division of Criminal Investigation (DCI). Any criminal history dais e0neemit n1e Ilial is main ai ed by the 1 ybc released as allowed by law. REeiverSigrt_ _ U— Iowa Criminal History Record Check Results (DCl usa only) As of� a search of the provided name and date of birth revealed; ❑ 1\o Mourn Criminal History Record foul)d tarith DCI t ' i" C,r1 Iowa Criminal History Rvooyd oltached, DO # tP'C4q�� U o pCl n11La1$ Cr DC1-77 (08125/10) Received Time Jun, 1. 2015 11;20AM No. 8396 Jun. L. 2 U i 7 42hJVI 9 1 v of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00829076 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF I DATE PRINTED- UCI:00829076 2015/06/02 NAME: ALAWNEH,RAFAT ARMAD DOB SETS RAC HGT WGT EYE HAIR SKN POB 19760906 M W 509 191 HAZ BLK FAR YY ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 20060307 AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 02 IA STATUTE IA711.3-2 ROBBERY 2ND DEGREE - 1978 TRK#: 1AD03LICI COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.2(6) ASSAULT COURT CASE ID: 06521 FECROB2572 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: IA003LIol RESTITUTION SENTENCE DISP EFF DAT FINE $100 20081126 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 ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS EASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION r R'0 9N P. 7 i' i .1rdWa Department. men of ynl two -i' --prof" . Pti J3t7 14�CC4, C<"'.,'9 yli.1Ac-, 4A :{(42111_ Certified Abstract of Driving Inquiry Date:�i 6/19/2015 DL/ID #: 959AA9537 (IA) Name: Alawneh, Rafat Class: A Address: City/State: Mailing Addreosl: Mailing City/State: Convictions' i I Ahmad 1453 DICKENSON'. LN IOWA CITY, IA 522409163 1453 DICKENSON LN IOWA CITY, IA 522409163 Audit #: Issue Date: Expiration Date: Endorsements: Restrictions: Date of Birth: Sex: 6135854 Tansportation �i�ll t Iii � 1 b�Cf1 Recrd " tomer #: D Status: DL Status: 07/18/2012 4DL Status: 09/06/2015 IDL Cert Status: NONE DL Med Status: NONE estriction 592 Supplement: 9/6/1978 IA M 10/09/2013 History Information 212458 EXP VAL Non -Excepted Intrastate None None Citation Date i Conviction Date ACD Ex lanation — �ounty JUR 06/08/2007 06/25/2007' 592 Seed ] hnson IA 07/11/2013 10/09/2013 S92 Seed J hnson IA Accidents -II Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number UR 11/09/2007 404038 I 02/02/2008 423667 I � � I Name: Alawneh, Rafat Ahmad DL/ID: 959AA9537 Pursuant to Iowia Code:. §321.10, I, Kim Snook, Director of Office of Driver) Services, Iowa Department of Transportation, do hereby certify tha 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 rrently in the custody of said Office, and that I have been authorizeId by the Director of the Iowa Department i of Transportation oto so certify. In witness whereof, I have caused my signature and the seal of the Department to be �et upon this document, at Ankeny, Iowa this date: I r � 'i 6/19/2015 `.� Office of Driver Servic$s �•""'�~ Iowa Department of Tla nsporation ID•�59AA9537 Name: Alawnehi Rafat Ahmad DL/.