Loading...
HomeMy WebLinkAbout16-182r (9 - 1 -1 l IDENTIFICATION NO. + _ (Office Use Only) 71. ally" APPLICATION FOR TAXICAB I 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 Street Iowa city. Iowa 52240-1826 Failure to complete the "required" /reformation will result in denial of the application (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name (REQUIRED) 2. Address (REQUIRED) �l 1r1u?.�S S F Cart \vC���, t -A \ 3. Contact Information (REQUIRED) Email: i .wd� ukN cJ� -Lo Cell Phone: �s1��3(I �S Z (A wri n communication sent via email) 4a. Chauffeurs License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) jA W 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Tyne of offense Where When jF� 4-rn y�'Ssne r i©WrxL\�-`ntCC What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended ead Guii Have you been arrested / charged with any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where Other When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your drivers license or chauffeurs 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 p6ptiridv t[game(s)- r' -i —moi DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE�41t�iTIIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CI}IEF REWIEWM You must apply for an individual Department of Criminal Investigation Report (form avairptile upow request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) r'' 0712015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I here y certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number aj 61 A A 1(n qC2 issued on Uhgb�i xpiring on 1 f /j2 1,2o I S . 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, 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 Cade. (Needs to be signed In front of a Notary Public) Signature of Applicant \ Date_Lf9.1�J5 iNiiiHMtiilHHfiiNiHHAHiiif YYFMMMMMtiHiMi}!f}MifiHF4Y: R}it}htM:kHMi M}}hF .....tfliMiiiiifkkHfY< fkifleaRM}Miiifiiik#HkfH STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by i h ��k+ "1 A GQ %Aq c.) on this C� day of 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 9-kof of Iowa CU (Title 5, Chapter 2, City Code). license_ Z Z 7 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. Signahhe of City Clerk or desig es gate CIMWAXIDWVDADCrMF'LMD14emutl0d00C 03120155 N CO i!#f;ffHYiRMff: i;k}HH}iflrff{yf}{i}}}}iyrtiff}!t}}}M}HH}fifiilikHi}fH}kMlfH}f}#H}fif}tfffftif}}flMtftili]!ft}MHt�AAlhA}«H<f!!iH}i L7 n4 Office Use Only Approved application r, DCI report State certified driving record N Website update a CIMWAXIDWVDADCrMF'LMD14emutl0d00C 03120155 uct. i,, iv i) It:iorivl ulv OT I,rlminal investigation No. 6112 Y. 1/1 Pro m:v, [y o, ,ows a ily Ciera c,lllce 510 56a6409 10/16/2016 19:46 =Goo P 002/002 STATE OFJOW -A Cii-iilxli>iaai ffTistory Record Check Request Form" DCI Account idumber: W a•r' - _— (iral,er,=role) To: Iowa Division of Criminal lnvescigation From!City of Iowa City Support OperaFioos Bureau, 1"Floor• ' City CIor1Ps office 215 B. 7a` SErect 410 r. Vissbin¢ton Street 11es Moines, Iowa 50319 — --• _-- (e1—e--=)-W56066 ,.. (515)725-6090 Fax Phone: 319-356.5041 h'Axt 319-356.5447 1 am requasli112 at, Iowa Cllfllinal Mietrov RnnnrA Oh..,.L ,.... Last Name (mandamrl) First Name (mandatary) Mddle Name treeonmended) -S'r Cl Date of Birth(maadatary) Gender(mandno- SOcialSectlri Number(-aCommeuded � I 214ale �]ITemaIe 3 — �S S W?iver Xnforrn17110a.- WilbouI a signed waiver from the subject orthe request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 6P2.2.1tor compete criminal history record information, as allowed by law, always obtain a waiver si nature'from the subject of the request. Waiver Release: l hcxs5y ai%,e pmni7sion hr the above requc;liag official to eondua an 10 VA nhnind hill Or/ record Cheek wish the Division of criminal lureniseiion (DCI)_ Any Criminal history data eoneemin& late abet is mab,ldned by Ulu DCt may be relused as a11OMe6 by laay. WaiverSi;nnlure: Iowa CI irninal Iiistor r Recard Check Results As of_ f qp/ &5- J a search of the provided name and date of birth revealed: Tf'•'i' No IoHa Crintiaal History Record found with /JCI f—.. Iowa Criminal History Record attached, DCT #- 3L •'' DCl initials "'A -r, tV ulzil iu) Received Tilde Oct. 14. 2015 1:35PM No. 0155 MCI list 01113) N -S'r Cl f i7'i7 iM M un. i�. 1015 N:11M Uiv or Oininal Investigation Terry E. Branstad Governor Kim Reynolds Lt. Governor October 15 2015 To Whom It May Concern: No. li /12 Y. 2%1 Department of Public Safety Roxann M. Ryan Commissioner The Iowa Division of Criminal Investigation believes the attached record is the same individual as the subject of your request, If you feel that these results are in error, you may provide fingerprints for positive identification. Please contact our office at 515-725-6066, between the hours of 8 a.m. and 4:30 p.m., Monday through Friday with any questions or concerns. Thank you, Iowa Division of Criminal Investigation DIVISION OF CRIMINAL INVESTIGATION • 215 EAST 7Y+STREET • DES MOINES IOWA 50314.0041 515 725 6010 Integrity, Fairness, Respect, Honesty, Courage, Compassion, Service N O E7 cn n 7-1 DIVISION OF CRIMINAL INVESTIGATION • 215 EAST 7Y+STREET • DES MOINES IOWA 50314.0041 515 725 6010 Integrity, Fairness, Respect, Honesty, Courage, Compassion, Service Uct. 17, IM 11:IIrM Ulv of (,eirainal Investigation N0. 8112 F. 9// IOWA CRIMINAL HISTORY DCI 00638420 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- DCI:00638420 _ 2015/10/15 NAMEOL,IBRAHIM AEDELRAHIM SES RAC HOT WGT EYE HAIR SRN FOR 1.9 D0101 M W 511 160 BRO BLK MBR SU CCH RECORD •*k 01 ARRESTED 20010216 AGENCY: IA6520200 IOWA CITY PD CHARGR NO- 01 IA STATUTE IA123-47(4) PROVIDING ALCOHOL TO MINOR TRK#: 100160101 COURT DIGPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123,47(2)-A POS0900ION OF ALCOHOL UNDER AGE - 1ST OFFENSE COURT CASE ID. 06521 SMSM040324 CHARGE CLASS: MISDEMEANOR CONVICTION TRK((: 100160101 SENTENCE DISP EFF DAT FINE $50 20011003 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION: BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION e.� a an O L DOT www.10w(300t.g0V SMARTER I'IMUFF. 1 CUSTOM' R DRIVE' Office of Driver Services PO Box 9204 : Des Moines. IA 5030"204 Phone: 515-244.91241800-532-1121 1 Far: 515-2391832 wwwrJowadot.gor Certified Abstract of Driving Record Inquiry Date: 10/14/2015 DL/ID s: 961AA1640 (IA) CDL Permit Class: None Customer is 1336592 Class: D CDL Permit Issue None Date: Office of Driver Services Name: Gangol, Ibrahim Audit a: 4679677 CDL Permit None Abdelrahlm Expiration Date: Address: 811 HUGHES ST Issua Data: 09/16/2D30 COL Permit None C7•'. Endorsements: Name: Gangol, Ibrahim Abdelrahlm DL/ID: 961AA1640 Expiration Date: 10/22/2015 CDL Permit None Restrictions: City/State: CORALVILLE, IA 522412143 Endorsements: 3 ID Status: None Meiling 811 HUGHES ST Restrictions: NONE OL Status: VAL Address: Restriction None CDL Status: None Mailing CORALVILLE, IA 522412143 SUPPlememe CDL Permit Status: ELG City/State: Date of Birth: 10/22/1980 CDL Cert Status: None Sex; N CDL Med Status: None History Information Accidents - Accident Involvement Indicated does NOT mean the Individual was at fault or given a citation. Accident Date Case Number IUR 08/252011 646137 IA Nana: Gangol, Ibrahim Abdelrahim DL/ID: 963AA1540 Pursuant to Iowa Code §321.10,1, IOm 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 cur Dover 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, love this date: � j}'•• •••' Office of Driver Services - i711 Iowa Department of Transpertatlon C? - At r 1+1� C7•'. i Name: Gangol, Ibrahim Abdelrahlm DL/ID: 961AA1640 r1�