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Home My WebLink About15-220Authorization Number_ 1 l 1 (Office Use Only) -- °:h Amer) c4rl cccmr CITY OF IOWA CITY APPLICATION FOR TAXI I MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 410 East Washington Street Iowa City,Jona 52240-1826 Failure to complete the "required" information will result in denial of the application d3f 9. ).35.6.-50fi0 (319) 356-5497 FAX 1. i uuuia Name (REQUIRED) 5, 4i }% ssr�N LiISi t HRSSAl�1 2 n Mailing Address (REQUIRED) Ir6h D 4,4 3. Contact Information (REQUIRED) Email: SaL010(I Cell Phone:q 0,91, 4. Prior experience in transportation of passengers: 1 Y? -S4 tt.1db-ssQy+ er-s -vib 0.i�2r, S f1 A GOWrt 1 �Woy% 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? kro Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? ,fo Type of Offense Where r , When 7 o 7. Have you been convicted of any traffic offenses in the last five years? 110^� j "q Type of offense Where Wbett ,,.H _. ca 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? NUJ Type of offense Where When 9. Havyou 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 hereebbycertify that J h v ss ed to me by the Iowa Department of Transportation a valid Chauffeur's license number %{ � I -f- 4-- 1 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) r� 1 Signature of Applicant Date U l 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 S lr.�n j ._Q _ �Ll��SScr�. On this J -93E-% day of ter %- .3ol NWENDY S, MAYER commss,on Number 726426 Notary Public and for the State o owa y iaw. _1 I 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). SignatuJ ofPol' ie or designee /0-a'C:Zq 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. - wr ie s Signature o `City Clerk or designee A0 '_2 �? / �z Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 51/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update cierw MIDrz,voAoceAPaL92014amended.Doc 09/2014 6t. 21, 2014 9:22AM Div of Criminal Investigation ,''I u. to l7 J. IVIw C . , , �I k `/I lVnu v11r I, I ( 111./1 ,11 I It h 1' . Ili CheckIs Request , 1 I To; Iowa Divislou of Criminal Investigation Support Operations Bureau, 1't door 215 t, 71" Street Dos Wlolnes, Iowa 50319 (SIS) 725-6066 (313) 729.6090 Fax T am reanectine- an Inwa Criminal History Reeoi'd Check on: NNo 3505 PF. 1/1 DCI Account Number: 69-2'F (if sppli cablc) From: City of Iowa Cif City Cleric's Office rsC NamO mandato 410 E. Washiogtola Street " Iowa City, Tia 52240— SSt4N - ry Phone: 319-356-5041 :-. w 7 Fax; 319-356-549 " r:; + "b n d - spa obfalnailvalverai nature kern tho subjod of the req nest. w itiver1Release:thembygivepemisslonfortheobovcrrgoestingofficlalIownduaealowscFlmhlelhltloryrcwrdclmckwilhtheDlvlslonofMlhlal Last Name (1handamry) rsC NamO mandato Middle h1a1110 recommended EL PIAS5AN SAL�4P SSt4N Date of Birth (mandatory) Gender (mandatory) Social Security Number(rcccmmondcd) 06 /0 g/,9 7 Male ®Female 962 `- 6o- b 6O I W01yer Liformottaft -, Without a sign td waiver from the subject of the request, a complete oriminal history record may not be Yeleasab[e, per Coda ofTowa, Chapter692,2, Ior cal let crlminal hlsiory record Informafion, as allowed by law, always obfalnailvalverai nature kern tho subjod of the req nest. w itiver1Release:thembygivepemisslonfortheobovcrrgoestingofficlalIownduaealowscFlmhlelhltloryrcwrdclmckwilhtheDlvlslonofMlhlal 1lvesLiga11Uo())C0. Any criminal history dela conmming me iliac is main) ahscd by rho DCl maybc releasrd n2 allowed by low. Waivermpa(rr rLe 7/ til lo'cwa I°iniinal History Record Check Results As o f I a search of the provided mune and date of birth rovealed: lk No Iowa Criminal history Record found with DCI ® Iowa Criminal History Record attached, DCI DCIinitialg bA ) Received TiNo. 3229 ZIUWADOT r'-wo 1iitV`d1 JoW+0d0tgov SMARTER I SIMPLER 105TtlM R DRILEN..� .6ffic Office of Driver Services PO Bax 9,04 ; Des Moines, IA 50306-9204 Phone: 515-24-4-91241 8.00-532-1121 1 Fax: 515-239-1837 wwrtiowad,ot-gov Certified Abstract of Driving Record Inquiry Date: 10/17/2014 DL/ID #: 789AK7776 (IA) Customer #: 6203841 Name: EI Hassan, Salah Class: C ID Status: None c®�BRry Hassan Beshir ces ce of Driver eof lTransportation CC Address: 60 PENN OAKS DR APT Audit #: 7897776 DL Status: VAL 7 Issue Date: 03/19/2014 CDL Status: None City/State: NORTH LIBERTY, IA Expiration 06/06/2019 CDL Cert None 523179139 Date: Status: Endorsements: NONE CDL Med None Status: Mailing Address: 60 PENN OAKS DR APT Restrictions: NONE Restriction None 7 Date of Birth: 6/8/1973 Supplement: Mailing City/State: NORTH LIBERTY, IA Sex: M 523179139 History Information CLEAR DRIVING RECORD Name: EI Hassan, Salah Hassan Beshir DL/ID: 769AK7776 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!el."§� 10/17/2014 [O IOWA *s c®�BRry ces ce of Driver eof lTransportation CC =S Iowa Department CC �� Name: EI Hassan, Salah Hassan Beshir DL/ID: 789AK7776