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Home My WebLink About16-199rtJt�_ CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319)356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. ) � — N4 (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 3. Contact Information (REQUIRED) Email: (All written 4a. Chauffeur's License expiration date (REQUIRE[ b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: mmunication sent _23-\k,, Last Cell Phone: "2, 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Pead Gui the :,da/,,e.,v 7. Have you been arrested / charged with any traffic offenses in the last five years? YDS Type of offense Where (:e-m—J 'rd% -30. When 1-0 k1- What 3 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? tf Q Type of offense Where 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please (irk When o <j —� i 44? tNe r4iine(s rn I ri DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CIERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REV@III You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 ar% APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that 1 have issued to me by the Iowa Department of Transportation valid Chauffeur's license number s cC Ar ,s 3 issued on � —k�- s expiring on � _� Z I understand that if 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 provisionstDf Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature ofA—pylic_. — Date C, \ ##ff*fti***M**Rtf*fM*#�4*h**+f#+fY#111ffM#114fffiMffR*******#1p1f*4f1Hff*1fHt*RR**#*++###H#####Y###Y##f#iff#'+f1f1R4ffff RMk*MffR*R4k*MR*R##**RR STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by FN cS,: on this -71-3 day of —Ar. � —,I 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 >VY Signature of 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. Signe of City Clerk or designee glrZ/� Date M1OJ Office Use Only n Cn —� 1> �i M =4 i— Approved application =sM rn DCI report <r- -0 State certified driving record r Website update N 0 CIerkrrAXIDRNBADGEAPPL92014ame ed.DOC 03/2015 prSep. 6: 2016„ 9:16AM,,.,Div of Criminal Investigation ,,,No.2392ragP.. 7,02,00 STATE OF 1OVV \ A e•$pr �... ( III 1I Iii iI•,�t Mud Check Sof i�- �i f n1 1 ''. DCI Account Number: • fl To: fowa Division of Criminal Investigation SupportoperationsBureau, 131Flo6r 215 B, 71A ,Street Des Moines, Iowa 50319 (515) 725-6066 (515)725-6080 Fax I am requesting an Iowa Criminal History Record Check on: From: Cita, of Iowa City - CI(y CIer OffOffice 410 R. Washington street Iowa city, IA 52240 Phone. 319-356-5041 Fax: 319.356-5497 Last Name (mandmory) Mrst Name (mandatory) Mddle Name trcmnunmded) A—/q Date of Birth (mandatory) Gender (mandatory) soeial SC—C rl r Ntlmber (recpommended) ale ❑Female WntperiHfOrnlattonc Without a signed waiver from the subject of the request, o compidte criminal history record may not be releesable, per Code of lows, Chapter 692.2. For eomolete criminal history record itnfot•motion, as allowed by low, always TfalverRelease: lherebygive pennisslonfor theova seg1:30fi;officialtoconduuantowaeriminaIhistory record chccicWththe DivisionofCriminal 1ARstigotion(OCI). Arty criminal hislorydala concemin, 1its0aiglained br dlepCl may be Wetted es Allowed by laky. Waiver Signature; a lows Criminal History Record Check Results r• (DCI Ase only) r.•p As of�(�/ /( a search of the provided naine and date of birth revcaleci:• .,,-, - . , No Iowa Crhuinal Ijistory Record found with DCI { Iowa Criminal history Record attached, DCI DCI initials. lil.w DCT -77 (08/25/10) Received Time Sep, 1. 2016 3:16PM No.21 Sep. 6. 2016 9:16AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00029076 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2016/09/06 DCI:00829076 NAME: ALAWNEH,RAFAT AHMAD DOB SEX RAC HGT WGT EYE HAIR SKN POE 19700906 M W 509 191 HAE ELK PAR YY ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 20080307 AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 01 IA STATUTE IA711,3-2 ROBBERY 2ND DEGREE - 1978 TRX# : IA003LI01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.2(6) ASSAULT COURT CASE ID: 06521 FECR082572 CHARGE CLASS: MISDEMEANOR CONVICTION TRXW : IA003LI01 RESTITUTION SENTENCE DISP EFF DAT FINE $100 20081126 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 �1 No, 2392 P. 8 Iowa Department of Transportation Office ofDriverServic PO Bot1ollFree)80U-5321121 Box. 9204, Des Moines, IA 50306 92t}t 515-244-9124 FAX-5152391837 Certified Abstract of Driving Record Inquiry Date: 9/8/2016 DL/ID #: 959AA9537 (IA) Customer #: 212458 Name: Alawneh, Rafat Class: A Ahmad ID Status: EXP Address: 1453 DICKENSON Audit #: 9413929 LN DL Status: VAL Issue Date: City/State: IOWA CITY, IA Expiration Date: 522409163 Endorsements: Mailing Address: 1453 DICKENSON Restrictions: LN Mailing IOWA CITY, IA City/State: 522409163 Convictions Date of Birth: Sex: 09/11/2015 CDL Status: VAL 09/06/2020 CDL Cert Status: Non -Excepted Intrastate NONE CDL Med Status; None CDL Intrastate Only Restriction None Supplement: 9/6/1978 M History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Alawneh, Rafat Ahmad DL/ID: 959AA9537 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 1 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: War h 9/8/2016 IOWA' D, 0. T.1160 S ,Flo� Office of Driver Services Iowa Department of Transporation Name: Alawneh, Rafat Ahmad DL/ID: 959AA9537