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HomeMy WebLinkAbout16-0611 l 1 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, / If - /moo t (Office Use Only) APPLICATION FOR TAXICAB 1 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 4a. Chauffeur's License expiration date (REQUIRED) O b. Taxicab Business Name (REQUIRED) _ jp I u P 5. Prior experience in transportation of passengers: AZ, Middle y Last 12a ' t2 z� VO Cell Phone: via email) 6, Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? _ MD Type 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? 6(0 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? l �t io 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 narme(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW r.. 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 c rt'ty that I have issued to me by the Iowa De artment of Transportation a valid Chauffeur's license number A� 9bo issued on expiring on© 0 2 . 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 pr 'l ion o7tleS,�Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant i Date _a c)9(s STATE OF IOWA ) COUNTY OF JOHNSON 1 Subscribed and sworn to before me by 1<L 1 LQ �1 . }� Al,, t4 o X on this day of A,Acr r® -7—D) I o . 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). 7 Expiration date of Chauffe 's license aZ 3 21 6 Sig ature of Police Chief or de ' be Dat 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. SignAQre of City Clerk or designee to Office Use Only Approved application DCI report State certified driving record Website update ClerkrrAXIDRIVBADGEAFPL92014amendedDOC 0$/2015 Mar. II. ZU16 III:7bAM Uiv of Criminal Investigation 03/11/2010 DD 942 40243 P. Iosiaos ST ATE OF IOWA Cly Minal Hastory Record Check p Request Form To: Iowa Division of Criminal Investigation ,Support operafials flueeau, t" Floor 235 E. 7"' Stvect Des Moines, Iowa 50319 (515) 725-6046 (515) 725.6080 Fax I am reauestinw+ n Tnv,a (,rhinal Winn.,,, ne.,—i of.__,. _ VC1 Aocount Number, f -f e, ._ . Fran: City of Iowa Ccv City Cleric's Of'liCo 41013, washin ton 3sreot Iowa City., TA 52240 Phone; 319-356-5041 FOR; 315-356-5497 -- T asf lame (mandatary) 1F[CSt latae (;nandalory) _ „11p�iddle lame (rtconnnnelnded`) Date of Birth (;nandaiory) Gender (manaioD9 Social Security VU131ber recommended) C) �/ qQ/ L y s Male ❑Female l�� 'iil` o I V 4y r'ahler Infornantiot without a signed waiver from tho subject of the request, a complete crilnlnal history record may not be releasable, per Code of Iowa, Chapter 692,2. For complete criminal history record information, as allowed by law, aim-ays obtain a waiversl nature from the sub•ect ofihe re nest. Xaiver Release: I herepygivepermission for tla abmve regotsling official to conduel m lova criminal histo ec haveuivallon (DCI). Any criminal history dela conceroing athal' aimained by the llCl may be raleased as ollvwcd by l81Vhecic with the Division of Criminal—�— r' rtiver.j'ignf lyl'e: — .� 2\. Iolv3YalCriminal History Record Check Results � (Oclnseonl,.) As of 1 � t 1 � le� a search of the provided name and date of birth revealed: N No Iowa Criminal History Record found with DCl"r+i 1 Iowa Criminal History Record attached, T)CI #}_ ;.` > DCT initials_,___ DCI.77(08/25/10)-— Received Time Mar.11. 2016 H IAM @x,9479 :,•:� DOT vv wv iowedot.nov SMARTER I SIPAP'L�E I CUSTOMER:. DRiVfE'4,., Office of Driver Services PO Bogy; 9204 Des Moines- IA 50 30 6-9204 Phare. 515-244-E'124 1200-532-1121 1 Fix 515-239-1837 WN°r:.lawadol. JOY Inquiry Date: 3/1/2016 Customer #: 6401617 Name: Ahmed, Khalid Mohamed Address: Hamid Address: 2420 BARTELT RD APT 2C Certified Abstract of Driving Record DL/ID #: 936ALS004 (IA) Class: D Audit #: 9427136 Issue Date: 09/16/2015 Expiration Date: 02/20/2022 City/State: IOWA CITY, IA 522462707 Endorsements: 3 Mailing 2420 HARTELT RD APT 2C Restrictions: NONE Address: Restriction None Mailing IOWA CITY, IA 522462707 Supplement: City/State: None DL Status: Date of Birth: 2/20/1991 None Sex: M History Information CLEAR DRIVING RECORD Name: Ahmed, Khalid Mohamed Hamid DL/ID: 936AL8004 COL Permit Class: None COL 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 CDL Med Status: None Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that Iam 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: �ti0�•"'""•;`/kyr 3/1/2016 D. 0. T. `'Offic of Driver Services IoweDepartme Department Transportation Name: Ahmed, Khalid Mohamed Hamid DL/ID: 936ALS004 -, .rt4.