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HomeMy WebLinkAbout15-256CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO )5- Z S-(0 (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 First Middle Last 1. Name (REQUIRED) 2. Address (REQUIRED) �6 \ AkA�-, <o \ t"r\\� t CA (�-2Zy \ 3. Contact Information (REQUIRED) Email:uy�kv-<--C �� Cell Phone: (�- X13 ^"Z��'2_ (AII writ n communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) \\ f I Zp vs— 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 �� V ��� ���yS� A t� _�, C�,A,•:t� fu i�n� v �.©fit\�� 'ZQ cl, What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended ead Guil Other 7. Have you been arrested / charged with any traffic offenses in the last five years? 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 When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pt idp tl&am%,,$)- DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE'eYikTIWED - DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF RIEWre You must apply for an individual Department of Criminal Investigation Report (form availal5fe' upNe request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 Ihereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number �� A 8 (L L( o issued on ro % 14(6c +sexpiring on 1 f Z13 1,70 1 S—. 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 �,\ Date_ .b _/ ]_ 11 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by L hcrc�, rtA� A . G—! XAXA SIJ on this i 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 C�f Iowa a (Title 5, Chapter 2, City Code). V license _ jjj� gyp- 22-Z 7 or designee 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. Signature of City Clerk or designee ClerWTAXIDRIVBADGEAPPL92014amended.DDC 03/2015 Office Use Only xX�+ Approved application DCI report State certified driving record Website update_ ClerWTAXIDRIVBADGEAPPL92014amended.DDC 03/2015 utr.ID, 2UI9 12IlprIV, uiv of �rlminaI investigation NoN112 '. 1/l P'om:Vtey of tows city Cie'¢ Ottte6 31B a6rs649Y 10/14/2016 13;462 -ZOO F.042/002 STATE OF IOWA Criminal History Record Check Request Form DCI Account Tfimber: W Z-�— (ifgipliwble) To: Iowa Division of Criminal Investigation From: Cify of Iowa City Support Operatious Burtau, I" Roor City CIcrI('s Office 215 Is. 7'h Street 410 r. VJasltin> ton Stree( WS Moines, Iowa 50319 — —�. -- —(.518}77,5-6tur (515)725-6000 Fax —�-- Phone: 319-356.5041 rax: 319-356-5497 1 am requesting an 10ia a Criminal history Record Check on: LastName(11,andacory) First 1i'ame (manda(ory) Niidt`l)e I'tyame (reaowmended) DJ &t0 0 ' lrth (_^ar,dalor Gender (naadamn9 ,.- Social Sesuri R'umber (recammended bi"aiver,lnf0i'maliotc Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. ror Complete criminal history record information, as allowed by tarn, always obtain a wYrom the su waiver si natureb'ee( o! [here acct. Wftiver Release: 1 hereby give pelmissioft for the abOVC rcguc,IIng Olreial ID conduct w, Iowa crbeioal hinory record dock with the bivisiVfr of Criminal hwesligadon (DCI. Any criminal history data concerning me that is maintained by rhe DCl may be released as Allowed bylaw. WaiverSignalarC: '�-' � �J( ,Iowa Criminal lH[istamRecord Check Results As of a search of the provided name mil date of birUt revealed: i' 1 No Iowa Criminal history Record round with DCI Iowa Criminal History Record attached, I)Cr DCI initials DC -77 (08125110) Received Time Oct. 14. 2015 1.35PN No, 0155 (L)CI Use only) U[i.i7. L017 I2'I(lV11 U v 0 GIinlinaI Inva,stigaiion Terry E. Branstad Governor Kim Reynolds Lt. Governor October 15 2015 To Whom It May Concern: No, M2 P. 2/! Department of Public Safety Roxann M. Ryan Commissioner The Iowa Division of Criminal Investigation believes the attached record is the same individual as the subject of your request. If you feel that these results are in error, you may provide fingerprints for positive identification. Please contact our office at 515-725-6066, between the hours of B a.m. and 4:30 p.m., Monday through Friday with any questions or concerns. Thank you, Iowa Division of Criminal Investigation N G:7 Ci i ! 9 DIVISION or CRIMINAL INVESTIGATION • 215 EAST 7M STREET DES MOINES IOWA 50319-0041 - 515-725-6010 Integrity, Fairness, Respect, Honesty, Courage, Compassion, Service U0t 17, 2U1h ILII/rlvi Div 0t Gririiral investigation V0811'1 IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI :00638420 DCI 00638420 PAGE 1 OF 1 DATE PRINTED - 2015/10/15 AMNii-"G GOL,IBRAHIM ABDELRAHIM dir SEX RAC MGT WGT EYE HAIR SKN POB 9800101 M W 511 160 BRO BLK MBR SU CCH RECORD *** 01 ARRESTED 20010216 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-47(4) PROVIDING ALCOHOL TO MINOR TRK#: 100160101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- Dl IA STATUTE: IA123,47(2(^A POSSESSION OF ALCOHOL UNDER AGE - 1ST OFFENSE COURT CASE ID. 06521 SMSM040324 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100160101 SENTENCE DISP EFF DAT FINE $50 20011003 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 DCT. 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. DIVISION OF CRIMINAL INVESTIGATION �.a +a .r -r: n 5T1 u 1A✓ ��� _ n.�e� IUVV DOT . .� winmiowaoot.gov SMIART€R i SiMPLEEF I CUSTOViJ DRIVEY� Office of Driver Services PO Box 9204 Des Moines, IA 50306-9204 Phone: 515-244-91241800-532-11211 Far 515-239-1837 VY w Iowad9t.gOi° Certified Abstract of Driving Record Inquiry Date: 10/14/2015 DL/ID #: 961AA1640 (IA) Customer #: 1336592 Class: D Name: Gangol, Ibrahim Audit #: 4679877 ID Status: Abdelrahim DL Status: VAL Address: 811 HUGHES ST Issue Date: 09/16/2010 Expiration Date: 10/22/2015 City/State: CORALVILLE, IA 522412143 Endorsements: 3 Mailing 811 HUGHES ST Restrictions: NONE Address: Restriction None Mailing CORALVILLE, IA 522412143 Supplement. City/State: Date of Birth: 10/22/1980 Sex: M History Information CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None COL Med Status: None Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number TUR 08/25/2011 646137 IA Name: Gangol, Ibrahim Abdelrahim DL/ID: 961AA1640 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: "W4 D. 0. T. Name: Gangol, Ibrahim Abdelrahlm DL/ID: 961AA1640 10/14/2015 Office of Driver Services Iowa Department of Transportation l) .