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Home My WebLink About15-277CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3191356-5040 (319( 356-5497 FAX IDENTIFICATION NO. /-5 ;?- -2-1 (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 1. Name (REQUIRED) First Middle 1—/d Last J A/ L�pill r f 2. Address (REQUIRED) 11 C! 4 P Z2<� �.� ��i� rAt 3. Contact Information (REQUIRED) Email: Cell Phone: I c( fl -i 526Q (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) !-47— 2a2o b. Taxicab Business Name (REQUIRED) Azl er Cctvr C,4 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 What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense /\/0 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 When DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTMED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICIll gVIEW- , You must apply for an individual Department of Criminal Investigation Report (form available uij�n request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 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 " Q 1�?04 issued on expiring ona—:�_7o&�. 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, Chaptel2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant l✓� Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by�_� tion l�. �. ,A>~W-L9 on this 1 0 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 Cpde). Expir " n date of Chauff license _ ignature of Police Chief or designee -7f �ZDzC Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CI'T-Y FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. - Signalure of City Clerk or designee D e a r , co e� Office Use Only Approved application DCI report State certified driving record Website update ciervrrnxiDamaADGE PPL92014amended,DDC 03/2015 CJIUWADOT Office sof Driver Services PO Box 9204 I Cres Mcdnea.. IA 50306-9204 Fri iTay' 515-144-9124 j 300-532-1' 21 i Fa=575-2311-1837 www mwado%cnry Certified Abstract of Driving Record Inquiry Date: 10/9/2015 DL/ID 9: 855AK1304 (IA) CDL Permit Class: None Customer #: 6285698 Class: C CDL Permit Issue None -- N d s.�®�`� ••.••••�/y/��p 10/9/2015 Date: Name: Ahmed, Babeker Hassan Audit a: 8876304 CDL Permit None coOffice Abass of lver eof Services �. O Expiration Date: oDepartment Address: 725 EMERALD ST APT D30 Issue Date: 02/26/2015 CDL Permit None Endorsements: Expiration Date: 09/07/2020 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522463034 Endorsements: NONE ID Status: None Mailing 725 EMERALD ST APT D30 Restrictions: Corrective Lenses OL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA 522463034 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 9/7/1973 CDL Cert Status: None Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Ahmed, Babeker Hassan Abass DL/ID: 855AK1304 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. r'_x In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Agkeny, IM a this date: cn -- N d s.�®�`� ••.••••�/y/��p 10/9/2015 coOffice r'i1C��nBR of lver eof Services �. O A oDepartment Name: Ahmed, Babeker Hassan Abass DL/ID: 855AK1304 VEL. er. cul) I )hlvl vIv of �'rIMInaI Invesflgatlon Nc, 9 h 2 2 F. 3// From:�Iry o, ,cwm CIorl tlIu t.1be5O497 10/21/2016 16:07 !307 P, oo2/oc2 STATE OF IOWA Cglmiaal History Reca.rd Check Request Form UCI Account Numbai 0f applicable) To: Iowa 6iviiiien or Criminal Ltvesttgatie0 From: Ci1V01`10wa City_ _ support Operations Bureau, I" Floor City Clerk's Office .2151✓. 7"' 5treel 410 T. Washington Stree[ RCE Moines, Iowa $0319 --- '- — _- (515) 725.6080 Fax '---- "---- Phone! 319-356-5041 Fah; 319-356-5497 I am ren uestiII rr an TnwA fk6n6,oI Wier r.. Do.,. A rr-e I Last Marne (mandatory) First Na—Me (nandmory) Aliddle Notme, (recommended) H Date of Birth (mandatory) Gender (n,anda nn9 Social Security Number (eeeomrnended u� – �� 7 �114a1e ®remaleG% 40 Waiver lttformarfoat, Without a signed waiver from the subject of the request, s eompiett criminal history record may not be releasable, per Code of Iowa, Chapter, 692.2, For cam lele criminal history record informalimi, as allowed by law, ahvays obtain a waiver signature from the sub eet of the request. r Waiver .Release: I bmby gfoe permission for the above rcgoeslimg official to conduct an Iowa criminal history record ebeck xih the DivO'orl of Criminal. fnvesdgation(DCI). Any criminal history data eonceming me Ilial is mainlaincd by the I mayberclealad as allowed bylaw, Waiver Signature: As of �Mo Ws - v'. 07 a search of (lie provided came and date of birth revealed: No Iowa Criminal History Record found with DCI u -- r Iowa Criminal History Record attached, DCl # DCI initials..— JA DCl-77 (08/25/10) Received Time Oct. 21, 2015 3;57PM No. 0585 (M use on) O