The URL can be used to link to this page

Home My WebLink About15-146IIIAC micift� =%41 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2 Address (REQUIRE/ IDENTIFICATION NO. _ 1' S —1 L4 Lo (Office Use Only) APPLICATION FOR TAXICAB 1 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 Midd Last 3. Contact Information (REQUIRED) Email: -j IW" ugt� �yj�Cell Phone: . � 5� (All written communication sent via email) 4a. Chauffeur's License expiration date (R b. Taxicab Business Name (REQUIRED) 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? Type of offense Where When y 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? ti/J 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? eLLC-, Type of offense Where When 9. Have you ever applied to be"ar lay ii j44j�i driver using a different name? If yes, please provide the names) .0 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECOR S��CCQMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individu"�f [Y@partrflCtSfr of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I he certify that I have issued to me by the Iowa Depa ment of Transportation valid Chauffeur's license number (,7Lj U ), 7;)I? issued on - - gpiring on �7 1 understand that if I falsery an wean q estions in this application, that this ap ication 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 (_ -�<:i� Date STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by (. r ya r= _ la lnf r. _T_ kd lnnu, 2 i this 2 7— day of S. MAYER Public in acid for the State 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)).. /� y Expiration date of Chauffeur's license f / ( l ��r" G VI Signature of 7 e Chief or designee f2 CL� j 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. igna re of City Clerk or designee Approved application DCI report State certified driving record Website update � D e aerwr lDRvBADGEAPPL92maamended. DOC 0312015 Ju2015 1 � 3 9 P M Div of Criminal Investigation o. 0190 F. 1 Cl o.,c ,�iripe bte U] *15-97 07/0e/2016 15:63 *161 P.oa2/002 Criminal llis al`Y Recard Cheek Request Form To: Iowa Division of C l-ilnihal lnvesligefiou Support Operatiocs 801enu, I"Floor 215 L 7'I' street Des Moines, Iowa 50319 (515)725-6066 (515) 725-6060 Rax est�an Iowa CTiniival History Record ycMale Dcl Account Number: (ifappifuAple) - Rrom:—6Lvf.fawft city __�---- City C)erlt's Oftice 4101%. Washington Street lows CIt , [A 52240 Phone: 3319.356-5041 Fav: 319-356-5497 . ®Female - "y s.--�„c• i --S S Wa!I'er'nf0pNia![07I, WiIt, oat a signed waiver from the subject of (lie roguesil a complete crihiioaI hIslory record may not be releasable, per Code of lows, Chapter 692.2. For com fete criminal history record Informat10n, as allowed by law, always obtain a waiversienature from the stal ofthe renurce WaiverTelease, I1mrc0y giee pcnaission for die about rtyucs(ing Ohpoial l0 COnducl an Ia1rA C mitral wi1 hislopvecord check 111hC Dioicicn of Criminal blvesligalinu (DCI). Any criroinbl hislory data eonecmin' me rbat i5 mainlailled by the DCI rcay be mleased as allowed by lair. Waive), Sign As of `1 3V i j — a searcll of the provided name and date of birth feve No lou"' Criminal Histov Record found wifh DCC ❑ Ipwa C:rinlinal llislwry Record at(achud, DCI # DCI initials,_-_ D(A-77--- Received Time Jul. 9. 2015 3'46PMi No. 2705 � (UCI u5c Only1 rn 7a O 'n ti r� C4010WADOT SMARTER 15RAPLU, 1 CUST®t F DRIVE'v VillNiy iC3�rJc�dOt SUV Inquiry Date: 7/9/2015 Name: Mohamed, Gamerelanbia Expiration Date: Ismail Address: 2608 BARTELT RD APT 2D City/State: IOWA CITY, IA 522462730 Mailing Address: 2608 BARTELT RD APT 2D Mailing City/State: IOWA CITY, IA 522462730 Convictions Office of Driver Services PO Box 92041 Des Moines, IA 8030 9204 Phane: -1115-244-9124 1 800-532-312t I Fax., 515-239-f A37 www _iow idot.goti Certified Abstract of Driving Record DL/ID #: 684A]7013(IA) Class: D Audit #: 7189403 Issue Date: 07/31/2013 Expiration Date: 01/01/2018 Endorsements: 3 Restrictions: NONE Date of Birth: 1/1/1957 Sex: M History Information Customer #: 6082673 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Da".e Conviction Date ACD _xplanat€an County 3utz. 03/01/2014 03/24/2014 N01 fail to Yield Right of Way Johnson IA Name: Mohamed, Gamerelanbia Ismail DL/ID: 684A]7013 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: •""••7,,01' ;'4 7/9/2015 IOWA 1.0. T.;�; r �.®��. Office of Driver Services nom"- Iowa Department of Transportation Name: Mohamed, Gamerelanbia Ismail DL/ID: 684A37013