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Home My WebLink About15-3031 — t CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. 5 — 3 C (Office Use Only) APPLICATION FOR TAXICAB I 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: I� SiYy 645 �aV 3 � %) .Cw Cell Phone: 26I ; 7qSO-f (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) r b. Taxicab Business Name (REQUIRED) _ i, I I/e vs at I C w(-2 Prior experience in transportation of passengers: a P4 ne ✓ I �+^� —fiy 2 c.✓f (�li'�1i i� 6. Have you ever been arrested 1 charged with any misdemeanors and/or felonies in this State or elsewhere? Tyge of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? YV o 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? N o Type of offense Where When c_> 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please providl rr e(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERT'Flo DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF..OEVIEW "71 You must apply for an individual Department of Criminal Investigation Report (form available upon6quest). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02(2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I here�b��GG, certify at I ave issued to me by the Iowa Department of Transportation a valid Chauffeur's license number OV)/( -A- %w issued on () yrJZ IS expiring ondLL 2y— } I understand that if I falsely 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 lova 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 q ti Ur✓(/ Date STATE OF IOWA ) COUNTY OF JOHNSON } Subscribed and sworn to before me by _y rc 5 f = AL,k� —\Ln c. on this 2 Z. day of J7P P_t,w1,u e 2LJIS 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 W2c(Lam] q Signatur ai ce Chief or designee ate 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. a re o Ci Ce `r0r designee 1�\ateae fr rn C=7 Office Use Only 72 CD Approved application DCI report State certified driving record Website update 0IeNIrAXIDRIVDADGEAPPL92014amended,DOC 0312015 Dec.18, 2015 V :28AM Div of CrirninaI Investigation No. 3W N. 1/9 F. _...._.— .0---- —..y Cle, ,. . le , 12/1712016 76;20 0349 P.0o2/O02 STATE OF IOWA Criminal History Record Check 6 ' Request Form TO: lows Aivisiun of Criminal Jnvestigaeimn Sllpport Operations ilurcau, 1" Floor 215 C, 7" Street Des Mollies, Iowa 50319 (515) 925-6066 (515) 725-6000 Fax all] requestinf: an low& -Al313 45s +AA 'y 6s, ; g 1)CI Account Number - _ L1LQ2 (irapplicahle) From: CllyullowaCity City Clerle's Ocoee �- 410 E. Vvushing[on 5leeet Iowa City, lA $2240 Phone: 319-356.5041 Fax; 319-356-5497 omale ®Female -:Ylk� HJ"P 1-ri -7�— G6 IS Waiver Xidforniali011: Without a signed waiver from the subject of the request, a complete criminal history record may nor be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record Information, as allowed by law, always Wallis a aVAIVP.-elan. f.—&Y— h. Waiver Release: I hereby give pennirsion for the ehovc regoening olireial to conduct an Iowa criminal history recusd check v4ih the Division of Criminal Investigntion (DCI). Any criminal hislray date conocmiog me that it main rained by Lite DCI may be released as allowed bylaw, Waiver Signature: tr (11W9conly) M} As of a search of the 1)1'ovided name and dale of birth revealed: "3 No Iowa Criminal History Record found with DO lova Criminal History Record attached, D0 # >- 1101 illiiialS :1J DC147 (08125110) — ^ — — Received Time Dec. 17, 2015 3:09PM No. 4129 :;ADGT ........... `"..Shs; fiFF; 1 :;, nF, 4Ei 9 LUST ri =Era wwa6lowedotgoy Office of Driver Services PO Boa 9204 Des Moines, IA 55106-9204 Phone, 595-244 9124 EGG -532 1527 ? Pa,,' 09&230-2837 wuv.toaltdo' elov History Information CLEAR DRIVING RECORD Name: Abbashar, Yasir Ibrahim DL/ID: 658A15404 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: Abbashar, Yasir Ibrahim DL/ID: 658A75404 Certified Abstract of Driving Record 12/17/2015 Inquiry 12/17/2015 DL/ID #: 658AI5404 (IA) CDL Permit Class: None Date: f�i Customer #: 6051382 Class: D CDL Permit Issue None C Date: Name: Abbashar, Yasir Ibrahim Audit #: 8988335 CDL Permit None Expiration Date: Address: 2424 BITTERSWEET CT Issue Date: 04/07/2015 CDL Permit None Endorsements: Expiration 04/29/2018 CDL Permit None Date: Restrictions; City/State: IOWA CITY, ]A Endorsements: 3 ID Status: None 522464100 Mailing 2424 BITTERSWEET CT Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CIN, IA Supplement: CDL Permit ELG City/State: 522464100 Status: Date of 4/29/1972 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Abbashar, Yasir Ibrahim DL/ID: 658A15404 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: Abbashar, Yasir Ibrahim DL/ID: 658A75404 rva 12/17/2015 4.1 cn r T f�i Office of Driver Services'��' t Iowa Department of Transportation C n