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Home My WebLink About16-184IDENTIFICATION NO. /1-0 % ?5 1 1 (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER C ITY OF I OWA 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" information will result in denial of the application (3 19) 356-5040 (319) 3S6-5497 FAX First Middle Last 1. Name (REQUIRED) mo t CA 1 Q Li —LS 2. Address (REQUIRED) 2n 14eekdf M.4 ?L 9 r to uln C ;Vj 3. Contact Information (REQUIRED) Email: NN G�1 14Z y tbri - Cr) wr Cell Phone: � 19 R53 �o 4 g (All written commune tion sent via email) 4a. Driver's License expiration date (REQUIRED) UD /-t M41 57 b. Taxicab Business Name (REQUIRED) J C) WQY% 5. Prior experience in transportation of passengers: P 49 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? NO Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other n--J�e 7. Have you been arrested / charged with any traffic offenses in the last five years? 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? 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) 07/2016 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 �jZ �/y1/ /1 issued on SoW q expiring on !�f 1 21 Zc,Z3. 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 liw Date /V STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Mo. Int i rO A . M `L) Sine. %mon this ) 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 City of Iowa City (Title 5, Chapter 2, City Code). Expiration dat of Dr' er' is rise Signature of Palice Chief or designee Date Ll 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. �112uoe� A - -&Lz Sign ure of City Clerk or designee �- /- / (te_ Date 4114!11#a#}»•a+µ»»ww#ifaa»»f»1»!1w»ww!»!f»wwawa»1»a»aww»»a+f#a»aa»1+»»f4»»»11»1»1»1»1»1»1»1»»!»f»w»w»f!»»» Office Use Only Approved application DCI report State certified driving record Website update cwkrrAxioRNaADCEAPPu2o14Bmmaed ooc 0712016 Aug. 29. 2016 2:26PM Div of Criminal Investigation No. 1164 P. 1/8 FY.......-. 1 -. —v�- .-.., Clerl. - --- ---..�_. as/23/2ols lm:5.- -539 . ,....1/[103 STATE GIF ICDVV.A / CrinimO History Recoyd Check Reque§t ®rn� To: Iowa Divi9lon of Criminal Investigation Support Operadous Bureau, I" Floor 215 r. 7d' Strect Des Moines, Iowa $0319 (515)725.6066 (515)725.6080 Fax I ani reauestine an Iowa Criminal History Record Check on: DCl Account N awber: (if applicable) From: CityofIawacity City Clerk's Office dI0 F. Washiliton street Iowa City, IA 5224,0 Phone: 319-356-5041 Pax: 319.3565497 Last Name (111andalory) First Name (mandatory) Middle Name (rawnnaended) L'L.sheikk M6 Date of Birth (mandamry) Gender (mandatory) Social Secm•itq Number (recommended) 4/Z9 t f qj q Zme. ®Fernale 59, 17- G ci 5 Z Waive? Alformadion: Without a signed waiver from thesubject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed by law, always obtain a waiver signature from the subject of the request. h1/diver R¢le![.r¢;16rnhy aWe per,at::tontor Ibeabave rcquestiagomcial to wnduet an lovva criminal history record gteck tnth rbo Division oferiminal fm•estigadan (DCC). Any cdmhml history data eondeming me I im is maintained by the 13V may be released as allowed bylaw. 9/QI ver Sigreafffre: Iowa Criminal History Record Check Results (DCr ruc only) As of S ?242 , a search of the provided name and date of bit1h revealed: No Iowa Criminal History Record found with DCT 4! iJ �J Iowa Crimilial History Record attached, DCT # r l; I: DCT if itials—h-t-L) Received Tirme� Aug. 23'.�I2016 12:39PM No. 2418 CjiUV4A00T SMARTER I SIMPLER I CUSTOMER DRIVEN VVUWV.IOWadOt.gOV Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-1121 I Fax: 515-239-1837 www.loviadot.gov Inquiry Date: 8/23/2016 Customer #: 6461011 Name: Elsheikh, Mogahid All Address: Mohammed Address: 209 HOLIDAY RD APT 226 Certified Abstract of Driving Record DL/ID #: 978AM1157 (IA) Class: C Audit #: 9963458 Issue Date: 04/27/2016 Expiration Date: 04/29/2023 City/State: CORALVILLE, IA 522414004 Endorsements: NONE Mailing 209 HOLIDAY RD APT 226 Restrictions: NONE Address: Restriction None Mailing CORALVILLE, IA 522414004 Supplement: City/State: None DL Status: Date of Birth: 4/29/1979 None Sex: M History Information CLEAR DRIVING RECORD Name: Elsheikh, Mogahid Ali Mohammed DL/ID: 978AM1157 CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: CDL Permit None Restrictions: Iowa Department of Transportation 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 I ar 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 c 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: ""••.EP 1 ' r 8/23/2016 IOWA I .....i� Office of Driver Services Iowa Department of Transportation Name: Elsheikh, Mogahid Ali Mohammed DL/ID: 97SAM1157