The URL can be used to link to this page

Home My WebLink About16-146IDENTIFICATION NO. i ¢(O—ffice �Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) 410 East Washington Strcct Iowa City, Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (3 19) 356-5040 (319) 356-5497 FAX First p �j Middle Last �1 1 1. Name (REQUIRED) /1/I ��I r) ( /-T6D r- Mfg 71 i An �,HAfAFQ,p l� 2. Address (REQUIRED) I h Qr \pay -f r-, - 3. Contact Information (REQUIRED) Email: j<6(AK M -C) 2�)r /V\a, I , C-0 W)Cell Phone: I°I S 4'?_Z 6o-(:) (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) 5 / `Z o Z 0 b. Taxicab Business Name (REQUIRED) Sow n C 0. 5 Prior experience in transportation of passengers: t k cAr r� �D — Y - ,K K1 -4i C /� r 4 i� .n -ro -Q 4 C 'i^u u C A u ", t Pte, r a l ,-.. V-\ 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? _)0 Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other J 7. Have you been arrested / charged with any traffic offenses in the last five years? \/cam- , Type of offense Where When �tL4/70�2 T What happened to the charge? (Circle one) 1 Convicted Dismissed Deferred Suspended lead Guil Othep N r,,w 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?' Type of offense Where When w1. 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide tK' A I A- I ' c7 A s r Is, 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 —- 3 N C' -Z ( 2 issued on 5 12T�xpiring on � f \ 1 7 2a 1 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 allotary Public) Signature of Applicant . Date 25,/,--7a 16 .a STATE OF IOWA ) �n COUNTY OF JOHNSON ) "" Subscribed and sworn to before me by M h Q . t on this¢ ....'% day of "'JI In r..n 7f�i1e •• 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 O 1 � o i Lo? t-) Signature of 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. Signa of City Clerk or designeeDatA Office Use Only Approved application DCI report State certified driving record Website update A e , Clef r IDRIVBADGE PPL92014a,,e,,dedDOC 0312015 Jun.14, 1016 4:)IrM Div of Criminal Investigation No. 6290 P. 2/2 'rrem;Clly of Icwn pity Glerk Ofrlce 319 3666497 Do/ata/20115 16;16 SE40 P.002/0D2 STATE OF IOWA (Ci iiaina$ Mstory Record Check W Request Form To: Iowa Division of Clvnival Invesilgaflon Support Operations Bureau, I" Fluor 215 L. 7" Street Des Moines, Iowa 50.19 (515) 725-6066 ($15)'725-6080 rax 1 am reauestine an Iowa Crhuinal Mitto]V Rcenrd Check on - DCI Account Number:_YOLp Z--�" (if aPPiicnb)e) From: City of Iowa City -- City Clerk's Office 41013. Washington Street luwa City, IA 52240 rhone: 319-356-5041 Pa X: 319-356-5497 )Last Flame (mandatory) First Nanle (maodalory) AflddJa Ifame (r omnicndcd) ABDPLM �GREEP moHAd Social Securi ' RamUer (freon,n,rnaw A L-- i —_ M /kG DI" _ Date of SirtU (mand1ston9Q Gender (mandalory) NTale Waiver Information. Without a signed waiver from the subject of the request, a complete criminal history record may nal he releasable, per Code of Iowa, Chapter 692.2. ror complete erhninni history record information, as allowed by law, always obtain a waiver sl nature from the sublact of fhc re nest. {l�(flper lielCQSe:l hereby give permission fo Ie2NbPC'FTlplesti oofficial to mnducf en lona criminal hislor)•recofd 'leek with die Division of Criminal invesligaliau (DCI). N1y criminal history data con ermng me Thal is maiAa cd by the DCI may be rdcased as allowed by Jaw. WaiverSignart re: Crim1>na{ History Record Checlx 12esults (lC1115C001y) lTo�va As of r (p /_�y � a search of the )provided name and date of birth reveaJed: No Iowa Criminal History Record found with DCI CA :a Iowa Criminal History Record attached, DCI 9 -F J I DCI initials___ DCI -77 (06/25/10) FA Received Time Jun. R. 9016 4AIPM Nn -7167 EL )47J DOT Q SMARTER 151MRLEA I CUSTOMER DRIVEN www,towadot.gOy Office of Driver Services PO Box 9204 1 Des Moines, IA 54306-9204 Phone515-244-9124 1900-532-1121 1 Fax: 515-239-1837 www.iowadot.gov Certified Abstract of Driving Record Inquiry Date: 6/28/2016 DL/ID #: 463AF2313 (IA) CDL Permit Class: None Customer #: 5747667 Class: D CDL Permit Issue None Date: Name: Ali, Magdi Abdelmageed Audit #: 9103552 CDL Permit None Mohamed Expiration Date: Address: 1637 ABER AVE APT 8 Issue Date: 05/21/2015 CDL Permit None Endorsements: Expiration Date: 01/01/2020 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522454729 Endorsements: 3 ID Status: None Mailing 1637 ABER AVE APT 8 Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA 522464729 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 1/1/1980 CDL Cert Status: None Sex; M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 07/14/2012 08/16/2012 S92 Speed Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. \ccident Date Case Number JUR .2/18/2012 717412 IA 14/30/2016 918607 IA Name: Ali, Magdi Abdelmageed Mohamed DL/ID: 463AF2313 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: ''...... z 14, 6//2,,,88//��2016 IOWA'; - 1. 0. T. r 9BNEB $ Office of Driver Services Iowa Department of Transportation Name: Ali, Magdi Abdelmageed Mohamed DL/ID: 463AF2313