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Home My WebLink About15-207CITY OF IOWA CITY 410 East Washington Strcct Iowa City. Iowa 52240-1826 (319) 3S6-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. 15- -a D `L (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 �iav� Mule C /n 3. Contact Information (REQUIRED) Email: 9-tha 'ftiAac)-CMI'Cell Phone:A3/9%3Zl `73o ) (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) Jo vW(yY) 5. Prior experience in transportation of passengers: Tay 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) C'J cn DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATEIFLrD DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CEiV&W You must apply for an individual Department of Criminal Investigation Report (form availa5.4—bpoFrequ1 rn (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)<�=r " Na 02/2015 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When ^m�•«lL 1oV3"C �i� }�.�y ZaIZ What happened to the charge? (Circle one) Convicted Dismissed Deferr dl Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? w6 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?[� 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) C'J cn DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATEIFLrD DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CEiV&W You must apply for an individual Department of Criminal Investigation Report (form availa5.4—bpoFrequ1 rn (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)<�=r " Na 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 AE 53L5 issued on ��/iZ o/ expiring on o: f Z02C� . 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, Chap 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant- Date Date rn C%'L) S STATE OF IOWA ) COUNTYOFJOHNSON Subscribed and sworn to before me by N„�1 a y}. M l� �4CIYU�cY 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 Coge). , Expiration date of Chauffeur's license _ ignatureof olice Chief or des gnee 5l�/2cO 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. SrgnatGre of City Clerk or designee Office Use Only Da e ra Approved application DCI report State certified driving record i Website update r- e 1V Clete,ITAXIDRN6AOGEAPPL92014amendetl.00C 03!2015 I`WADOT VV -0A i0VVad0t. 0V SMARTER I g*`LER I 0 1,TC ;._. Ii, %, --L , _ Office of Driver Services PO BOY 9204 1 Des Moines, I:A 5030G-9204 Phone: 515,'44-&124 800-532.-1121 ( Fax 515-239-1P37 www' i Wanal.gov Certified Abstract of Driving Record Inquiry Date: 9/4/2015 DL/ID #: 424AF5395(]A) CDL Permit Class: None Customer #: 5612203 Class: D CDL Permit Issue None Office of Driver Services Date: Name: Hamid, Husham Hashim Audit #: 9076798 CDL Permit None Mohamed Osman Expiration Date: Amt Address: 2530 13ARTELT RD APT IC Issue Date: 05/12/2015 CDL Permit None Endorsements: Expiration Date: 05/18/2020 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522462719 Endorsements: 3 ID Status: None Mailing 2530 BARTELT RD APT 1C Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA 522462719 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 5/18/1975 CDL Cert Status: None Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Hamid, Husham Hashim Mohamed Osman DL/ID: 424AF5395 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: IOWA D. 0.1 Name: Hamid, Husham Hashim Mohamed Osman DL/ID: 424AF5395 9/4/2015 Office of Driver Services Iowa Department of Transportation t^�, Amt b t i r "dfTl a fV Seo. 1. 2017 4:26PM Div of Criminal Investigation No, 4695 12 ESTATE Orr IONV a " :'� � �'rilnir2a► Ic�iytur�, I�eeurci C�hec[t w RN11CO F011H '1`u: falaa bivisin0 nrCrininal Invesligafilru Suppurs Operalluns rla'eau, 1" I Inn,. 213 F. /I', 'St, eel bes biuines, iovya .50319 (515) 725-6066 (515) 725-6080 1/ax I aro requesting an on: IJCI Account 19t),nbnq, "fit xpplicahle)----- Prum; -s ay 0f Iowa Ci �„ C.'i1y'(:1crllsOrfice lOya City, iA 52740 Phone: 319-356-5041_ Pax:---- 13Male ❑Female Nam�e Z rr reltas r,njorMal"OJlr 1VilbOul a signed waiver from the subJecl of the request, a complete uimlhal f-- ,�st�ry record mals not ob r In a n, la per Code of f0wa, Chapler 692"2. For c0mm�lele criminal bisfOry record WIDI' nation, as allowed by laH ahvpy5 ohlaln a waiver si nature frau the sub-ecL of the re oast. HlOiver.Release.: 1 hcrrby glee Permission for the above requ. hmes,igaliml (DCI), Any rrimural hlslory dale wnceming me mal i3 rr'aivdr Signature: w to sand" an lona n'iminal history rewrd tl,cck.yilh 1111 nilllian of Criminal Pre CI may he released a3 sltoo'ed by �vwa E �rmtraa! H, tor, Record Check Results — -- Asof search W'the provided name and date of bink revealed: No )own Criminal History Itecnrd sound with 1.)Cl r11.: 11 Iowa Criminal llislwv kecord aliached I)Cl #9 (A !�67 .c F - - r Received Time Aug, 31, 2015 9 46AM No. 6831 LA (uCi ase ealt') � b �J s na Sep. L 2015 4 : 2 6 P M Div of C r l m i n a l Investigation IOWA CRIMINAL HISTORY DCI 00961507 NON CONVICTION PAGE 1 OF 1 DATE PRINTED- DCI:00961507 2015/09/01 NAME: HAMID,HUSHAM HASHIM MOHAMED DOB SEX RAC HOT WGT EYE HAIR SKN POE 19750518 M U $11 210 BRO BLK MBR YY ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTRD 20120725 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- O1 IA STATUTE IA708,2A(2)(B) DOMESTIC ABUSE ASSAULT CAUSE BODILY INJURY/MENTL ILLNSS TRK#: 1A00ESY01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- O1 IA STATUTE; IA708.2A(2)(B) DOMESTIC ABUSE ASSAULT CAUSE BODILY INJURY/MENTL ILLNBS(SRMS COURT CASE ID; 06521 SRCRO98029 CHARGE CLASS: NON CONVICTION TRK#: 1A00ESY01 RESTITUTION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20121119 PROBATION lY 20121119 UNSUPERVISED PROBATION, INFORMAL PROBATION REVIEW 06/01/13 DISCHARGED FROM 2.0130903 DEFERRED JUDGEMENT 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 BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DI ION OF CRIMINAL INVESTIGATION No. 4695 P. 2/12 1 .yr Aa 0-