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HomeMy WebLinkAbout15-239r 1 CITY OF IOWA CITY 410 East Washington Streel (�wa City, Iowa 52240-1826 \(319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. (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 3. Contact Information (REQUIRED) Email 20/1LO OZhzh --CCM Cell Phone: (All written communicdtion sent via email) na 4a. Chauffeurs License expiration date (REQUIRED) a 1pl b. Taxicab Business Name (REQUIRED) fi/TJ s G/L i� = f ec'i 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or"e1sewhce?12 Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Ptead Guilty Other 0 Have you been arrested / har ith any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where r 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 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0212015 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 2t( issued on v3/rteexpiring on I understand that if I falsely answer a ynquestions in this application, that this application may be denied. I agree 1hat 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 k=/ Date Z zi STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by t 1'. 0 ", IV), } . ,-\q M wd—, on this day of �I taPu Public in and for tPu�lic in and for the State-bf Iowa q P1 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 Chauffeur's license Signature of Police Chief or designee g -z-1 S ZQ a ...0 AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWAIITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. nee Approved application DCI report State certified driving record Website update Office Use Only CierwrMDRJVenocenrPe92014emendea.00C 0312015 Page 1 of 2 4�4�10VUADGT SMARTER 1 51,"A -F I CUIjTo i- DRAEN Office of Driver Services FO 80" -' 2,51 Des Nfoines, ; 5'S30 9'_54 Ft..-152�4-91241 SOGn32-121 I Fn'Ir3? Inquiry 9/9/2015 Date: Customer 5400638 Name: Hamad, Mogahed Mohamed Alhassa Address: 2654 ROBERTS RD APT 26 City/State: IOWA CITY, IA 522462741 Mailing 2654 ROBERTS RD APT Address: 2B Mailing IOWA CITY, IA City/State: 522462741 Date of 8/2/1980 Birth: Sex: M Convictions Certified Abstract of Driving Record DL/ID #: 241AD4645 (IA) CDL Permit Class: None Class: D Audit #: 8918904 Issue Date: 03/13/2015 Expiration 08/02/2018 Date: Endorsements: 3 Restrictions: NONE Restriction None Supplement: History Information CDL Permit Issue None Date: CDL Permit None IOWA *4' Expiration Date: CDL Permit None Endorsements: c�-a CDL Permit C-, None Restrictions: ID Status: -None —q ::^p',L I , DL Status: W,VAL :<tNpne CDL Status: T - CDL Permit ;tLG Status: CDL Cert Statue NoneM 1-0 CDL Med Status: None Citation Date Conviction Date ACD Explanation County 7UR 01/29/2013 03/05/2013 592 Speed Johnson IA Name: Hamad, Mogahed Mohamed Alhassa DL/ID: 241AD4645 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: 9/9/2015 9/9/2015 IOWA *4' f Office of Driver Services Iowa Department of Transportation 9/9/2015 Se IT 2015 aU11 M K of Criminal lnvesiigallon No.ro)U l Fro m'Ui[Y o[ lows ca[y dark .�rtrca Ana :lb bbaa/ 02/10/2 D'15 12.so Defies f•.UU2/002 STATE OF f0NAI A 5yyy r. `,. („t.flntlrt�l [strir�r RecoT€ i (tlecti � CegT€et41Sorfr2 Iowa Wvisiun of Criminal hivasligafimr Suppurl Operations Ilurrnu, I” Floor 215 E-. 9"Sfrecl Ties Melees, IOWA 50319 (515)725-6066 (5)S)725-6080 Tae )—au requesting an Jowa lz 61 of 01 SIC, ?/i 9 o Check Gender rn,. I fgftle D(:)Acawnit\hlmhvc �Ea�-2� �- fit aPPtlearilr,) City C'Ie] P& Offrce ,.910F]_.Washh (en Street Iowa Com, IA 52240.,_,_ I'h on e: 3T 956-5091 Far: 319-356-5497 ❑Bemale Name 1'POlvef INfoYrtlrt!$on: without a signed waiver from the sub)ect of the requeu�om tele —Cl i mina) be releasable, per Cadr of Iowa, Chapter 692,2, Fbr cornnlete trim1r I history record informatlU gF�greeord me), not ln obtaa�,H.air•ersiQnaLurefromthesubieetnffhertr,r,P�e nsAlfg>•�Fe bylaw. kihHaps /lf[Ve! RC/gg5g. 1 hertby givc en»i55ian f t v t:77~ ' t"vesLi ali0n DCI P er he eb0 a/eg0csling official to cundutJ en baro mmi0sl hie(oiy reeortl ahcck+vA the Pow.) uRr,7imiul 9 ( ). Any trimfnal hl5lep' date conceming me U,aa is rnain,oinea try the ucl may be released as anewed by laq i A a J riverSignafffre: — — — --- — — IPG nsc Duty) As of'-- q�js-15 a search of the provided name and date of bi11h revealed: L MY No Iowa Criminal Hislary Recind lbund with LICI to - rel - © kiN, Criminal 1-lisulry Kceurd attached, pf'J 11 .l,r=;� u� L IICI initials -- W Received Time Sep. H. 2015 12 26PN No, 1680