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Home My WebLink About15-205` r CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52 240-1 82 6 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) - 2. Address (REQUIRED) IDENTIFICATION NO. /5-5L05- (Office Jr' -5 5(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 Vle_ iddle Last 3. Contact Information (REQUIRED) Email: wul �v )?�C <<tr 49+ Cell Phone: q�Z S r L 1 (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED)) I oZ-/'l3 /Zo Z -Z b. Taxicab Business Name (REQUIRED) -f yiAe-,t Ca,., 5. Prior experience in transportation of passengers: 17 town c� Fy A�,.oJ.e-_ fidr 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? 410 Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? .410 Type of offense What happened to the charge? (Circle one) Where When 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 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please AjC c� DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE C RTIF 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify fiat 1 have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number V543 issued on o8/IZ/2°tW expiring on vz- 13/ Z, I understand that if 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 Date qb 1/15 STATE OF IOWA ) COUNTY OF JOHNSON ) l ✓h Subscribed and sworn to before me by L0 Li i l I ' \ 7 ll'i rR ttl i on this _ _ day of VVENDY S. MAYER NotarV Public in and fGathe State of Iowa 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 Chauf u 's license` Signature of PoTice Chief or d signee I IDate 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. Signat6re of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update ZZ5 11 -5 - Date , clerrJW1DRNBAo6EAPPLB2a14an,ended .DOC 03/2015 r' no S^ty C-5 u C:) cae clerrJW1DRNBAo6EAPPLB2a14an,ended .DOC 03/2015 00*4 �., -AhlOWADOT sre°AsTER I £WPL E -F a (LISTOWF DFIVE,a VWAV.1owadot.gov Office of Driver Services PO Box 9204 , Des P0101nes, €A 50306-920:1 Phone: 515 244-91241800-532-1121 EBax: 515-239-1837 vrvivl.iowadot.gpv History Information CLEAR DRIVING RECORD Name: Elgaali, Wail Mohammed DL/ID: 960ZZ4343 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: Name: Elgaali, Wail Mohammed DL/ID: 96OZZ4343 9/3/2015 "KVIV 06-evv� Office of Driver Services Iowa Department of Transportation Cn 00 Certified Abstract of Driving Record Inquiry Date: 9/3/2015 DL/ID #: 960ZZ4343 (IA) CDL Permit Class: None Customer #: 3342803 Class: D CDL Permit Issue None Date: Name: Elgaali, Wail Mohammed Audit #: 8347972 CDL Permit None Address: 2442 ASTER AVE Issue Date: 08/12/2014 Expiration Date: CDL Permit None Endorsements: Expiration Date: 02/13/2022 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522406731 Endorsements: 3 ID Status: Mailing 2442 ASTER AVE Restrictions: NONE None Address: DL Status: VAL Restriction None CDL Status: None Mailing IOWA CITY, IA 522406731 Supplement: City/State: CDL Permit Status: ELG Date of Birth: 2/13/1986 Sex: M CDL Cert Status: None CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Elgaali, Wail Mohammed DL/ID: 960ZZ4343 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: Name: Elgaali, Wail Mohammed DL/ID: 96OZZ4343 9/3/2015 "KVIV 06-evv� Office of Driver Services Iowa Department of Transportation Cn 00 M,_.•,�. I" I I I V.;�nln 0 1v ominaI Inve;tigaIicn No.3476 P 4/6 From;Clty ar lows Clry 11"' O""' 319 3666497 Oe/19/2016 1247 &211 P_003/003 STATE OF IOWA 0 Requesf Forin Criminal Iji,ior•y Record Chal, To: 14)wh Uivisicn of('rinlinai Invcstigafion 4111)Fbu1'l Uperafials B11 cau, I" Clour 215 L. 711 Street - Des R7ofneS, IOwa 50314 (.5I3) 725-6066 (515) 725-6080 N, an Iowa 0 2-/3/ 1g8(o :rec name p W01. I AJC] Account 1\hunber, 4oc)a- - P -_� •lif spplicablej----'-� P1 um: Cily -ul'Ina�a Cffj;__--- Ftty clerks orae - - 410 E. 6Vaahin ion 5'trec.t Iuga Clly, 1A 32240 Phone: 339-356-5041 _ ---.- E'ea., 319.356-5497 ��--------- 'Ird11V191e Mentale 5�0 95 Zi Ig Waiver 111foI7111'1601i: Without a signed waiver from Ihesubleef of the re, quest, s complete trim lnal history record may not be releasable, per Code 0flowa, Chapter 692,2• For comPlele criminal history record information, as allowed by law, aleays obtainawB;YCrs; nalUrefromlhCSuL'ectoflherequcsl, f4'oiverI2eieaSe:1heeepyg;eepenniseiunforrbcabovemGl¢sl;ngo dnlmconductan1Ws•acriminalbislorymcoldcheekwiththeDiv;sionofCrilnbly InvesligalioI (D I). Any criminal hiclory dais eoneernln= me Ihal is maintained by the DCI may be released as allowed by law. As of If 17ille]. Sid n(IfUref _..._ _.. 111•tVCale�i No lova Criminal hlislory Record Bund with De.] lows Criminal history Record attached, DO DCI -77 (08/25/10) 1XI iniiials__,_ (UCI use only)