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Home My WebLink About16-145� r ►r'III z �` + 11�Imi�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1 826 (3 19) 356-5040 (3 19) 3 56-549 7 FAX 1. Name (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 First Midd 2. Address (REQUIRED)c•n 3. Contact Information (REQUIRED) Email: Cell Phone: 3ld.5-1 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) rr 1 / o lf2,,-2I b. Taxicab Business Name (REQUIRED) _ 5. Prior experience in transportation of passengers: ti pc ,y S 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Alp Type of offense Where When What happened to the charge? (Circle one) -- A.:j Convicted Dismissed Deferred Suspended Plead Guilty.. Other,'_ Have you been arrested / charged with any traffic offenses in the last five years? 1 -y -z `o Type of offense Where When -- j What _l 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? 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) 0712016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number L� t JL S uo issued onaZL Q "< expiring onB t job / 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'' v Datec•, LaA ZZo STATE OF IOWA ) COUNTY OF JOHNSON 1 Subscribed and sworn to before me by in and for i h on this ma I have reviewed this application, DCI report, and the State certified driving record of this applicant and�have�deterxnirjed that there is no information which would indicate that the issuance would be detrimental to the safety, health orwelfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date o DC�wer's license 01 day of -1(� Signatu e o Police Chief or designee Date 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 Office Use Only Approved application DCI report State certified driving record Website update Date Qerk/rAXIDFO/BADGP PPL92014aI, nMed.Doc 0712016 F.nug. 3. [u uvi[4rivi�loru,v of mIna i investigat on No.Mb r. 2120 " - 08/01/2016 13;r� d601 r. —iDD2 Criminal History Recoyd Check Request Form To: to{ -n Bie•islon of Criminal Investigation Support Operations Btlreav, V Floor 215 E. 7'h St reef lies molnee, Iowa 50319 (515) 725.6066 (51.5) 725-6080 Fax I am renuestina an Intm f'r4m i„al t-atnr.,. DCIAccowitNumber:.-- G%Ccr-__ (It9NIrilCflbi C) From: CltkotlowaCjty _ Clty ClerIPs Office 41.0 G. Washington 9treel Io{ -a Citi_ Ili 52240 Phone; 319-336-5041 rax: 319.356-5497 — Last Name (n/andat0y) First. Name tmanda(ery) Middle Name peromm/Jcnd(cd) F -0/I / !/! " nate Of �31rElt (mandato ) Gender mandatory) Spcial ISeClll'It I�UQ]hel' (recommentled) i — 51 — `h 5 IaliVra Ce Ebamale �41Ll— 1 0 —3 33 Without a Signed watveY from the subJect of the request, a complete criminal history record may not be refer able,InfPei be releasable, per Cade of Iowa, Chapter 692.2. For complete history criminal obtain a waiver signature from the subject of the re nest. record htformatiou, as allowed by las-, always Waiver R eteas'e: 1 hereby give permission for the above requiting official le conduct an Iowa criminal hisloq' record clmck {villi the Division of Criminal Investigation (DCq, Any criminal history data wnccrning me that is moiuteined by she UCI may be released as allowed bylaw, }•i'arver SiaoRdrure: _'j�e��--- p� _� (UCI use only) As of 1 �� a search of the provided name and dale of birth revealed: No towa Criminal History Record found with DCI ® Iowa Criminal History Reeoid attached, DCI !F _7 DCI initials__ v DCT -77 (0 9/25) 10) Received Time Aug 1, 2016 1:16PM No 0666 C410WADOT www,iowadc)t.gov SMARTER i SIMPLER I CUSTOMER DRIVEN.:w.,�.,,, Office of Driver Services PO Box 9204 I Des Moines, IA 50306-9204 Phone: 515-244-91241800-532-11211Fax: 515-239-1837 v v.lowadot gov Certified Abstract of Driving Record Inquiry Date: 8/9/2016 DL/ID #: 834AK5407 (IA) Customer #: 6260655 Class: D Name: Noureldein, Gaffar Hamid Ali Audit #; 8819945 Address: 2534 BARTELT RD APT 1C Issue Date: 02/05/2015 Restrictions: Expiration Date: 01/01/2021 City/State: IOWA CITY, IA 522462721 Endorsements: 3 Mailing 2534 BARTELT RD APT 1C Restrictions: Commercial Learner Permit, Address: CDL Intrastate Only Restriction CDL Instruction Permit Mailing IOWA CITY, IA 522462721 Supplement: Expires 8/5/2015 City/State: Date of Birth: 1/1/1959 Sex: M History Information Convictions CDL Permit Class: None CDL Permit Issue None Date: given a citation. CDL Permit None Expiration Date: 11/22/2014 CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: Excepted Intrastate CDL Med Status: None Citation Date Conviction Date 02/08/2015 02/10/2015 ACD Explanation iM14 Fail to Obey Traffic Sign/Signal County JUR Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 11/22/2014 829671 SA Name: Noureldein, Gaffar Hamid Ali DL/ID: 834AK5407 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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: .••..••. 14 8/9/2016 IOWA'g' D. O.T..'�r iyaa�. OP�w ' � 9p O...$ Office of Driver Services ^s.. TM, -- Iowa Department of Transportation Name: Noureldein, Gaffar Hamid Ali DL/ID; 834AK5407