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Home My WebLink About16-180r � ✓1� lm 1 �� CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319) 356-5040 (319) 356-5497 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 er Middle 2. Address (REQUIRED) ?,4q2- 1956f, Avg / 3. Contact Information (REQUIRED) Email: OMer ebaa 1; erhf7l-Crt~ Cell Phone: _319 q'36 IZ A I (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED)112, b. Taxicab Business Name (REQUIRED) yzII aw COL 5. Prior experience in transportation of passengers: ( yar-, aa Xe entri 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? /-yo 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? Twe of offense 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? Nu Tvoe of offense Where When M a 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provid@ the pa 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) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa art ent of Transportati n a valid Driver's license number QL0 T" 4�yO issued on L )6expiring on i I understand that if I falsely answer any questions in this application, that this application may be denied. I gree 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 Date Q \ \ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this day of S40., A L AL_Z-D t' 10 Vill Notary Public iGnr heState of Iowa rM 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). w's license 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. Signatbm of City Clerk or designee ?_/-// D to Office Use Only Fri 4 Q --- Approved application DCI report �V State certified driving record ' o� Website update GeM/rA%IDRMIADGEAPPL92014am ded.DOC 07/2016 .Aug.30. 2016 1:05PM Div of Criminal Investigation No,2912 P. 1/4 From:Clty el Iowa City Clerk Otrloe 318 3666487 06/24/2016 12:13 0643 V.UV�/003 STATE OF ROWA Criminal History Record Check Request Form To: Iowa Division of Criminal lnvesttgation Support operations Bureau, l" Floor 215 E. 7, Street Des Moines, lows $0319 (515)725-6066 ,(515)725-60&0 Fez ts--- .d M. L..... DCl Account Number: C 'ODZ (ifappliceblc) From: —City of Kowa City. City Clerles office 410 E. Washington Street Town City, JIA 52240 Phone: 319.356-5041 Fax; 319-356-5497 J. P11114 HWwa-uu wvu v.,......... ....... Last Name (mandatory) .. First Name (mandatory) Middle Name (rccommmdc,l ��9aal 0rneK /v1Gha��4 Date of Birth (mandatory) Gender (mandatary Social Security Number (recommcnded) 6 � gg .Male ❑]Female U ' q 33� rq _ waiver Information: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2, For com le(e criminal history record informations, as allowed by raw, always obtain a waiver signature from the subject of (tic request. Waiver Release, t hereby give permission for the above requesting official to condocl an Iowa criminal historyrecord check wills the Division of Criminal invunieation (DCI). Any criminal his/ory dela concenting me dul is maintained by the DCI maybe rcicased as allowed bylaw, . Waiver Signature: Iowa Criminal History Record Check Results As of r a search of The provided name and date of birth revealed: [� No Iowa Criminal History Record found with DCI Q Iowa Criminal History Record attached, DCT 4 DCI initials " D N -77A... 1A10)nnlK to.nnptl hia IAU (DCI use mdy) o a AC Iowa Department of Transportation Dfbee 0f Drrvef Seroces (Toll Free) 9DD-532.1121 PO Sox 92D4, Des Manes, IA 503069204 515244-9124 FAX- 51 5-2 39 1837 CLEAR DRIVING RECORD Name: Elgaali, Omer Mohamed DL/ID: 960zz4340 Pursuant to Iowa Code 4321.10, 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: 8/24/2016 IOWA*"* :. D. 0. T. W Office of Driver Services Iowa Department of Transporation Name: Elgaali, Omer Mohamed DL/ID: 960zz4340 Certified Abstract of Driving Record Inquiry Date: 8/24/2016 DL/ID #: 960zz4340 (IA) Customer #: 3932089 Name: Elgaali, Omer Class: D ID Status: None Mohamed .� Address: 2442 ASTER AVE Audit #: 1251539 DL Status: VAL Issue Date: 08/24/2016 CDL Status: None City/State: IOWA CIT', IA Expiration Date: 06/06/2021 CDL Cert Status: None 522406731 Endorsements: 3 CDL Med Status: None Mailing Address: 2442 ASTER AVE Restrictions: NONE Restriction None Supplement: Date of Birth: 6/6/1988 Mailing IOWA CITY, IA Sex: M City/state[ 522406731 History Information CLEAR DRIVING RECORD Name: Elgaali, Omer Mohamed DL/ID: 960zz4340 Pursuant to Iowa Code 4321.10, 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: 8/24/2016 IOWA*"* :. D. 0. T. W Office of Driver Services Iowa Department of Transporation Name: Elgaali, Omer Mohamed DL/ID: 960zz4340 N O __ rn rn rn .�