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Home My WebLink About16-204CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 5 2240-1 82 6 (3 19) 3S6-5040 (3 19) 356-5497 FAX IDENTIFICATION NO. 1 lJO. �6y (Office Use Only) APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3_p.m,-Monday First Mitl to 1. Name (REQUIRED) ES 2. Address (REQUIRED) .2 6d^4 VJ W X P1 iL J&J Gr % 3. Contact Information (REQUIRED) Email:WLU.U-esa.t Lae;raR Ne Last K2A-t N 8SS— J2{3 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 40 /oZ /Z Of 6 b. Taxicab Business Name (REQUIRED) J(0 W P� N T -Ac- X I 5. Prior experience in transportation of passengers: %U-) c:;, y e a" A N-� c' 1ti c, C I N I s^y FiO a-" .e -/L C O U N 2.r (ErL 6 t Vr 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When A/ O What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When Al � 91 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When Nv m, 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please proyidelbe name(p) C-) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIEQQ� DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CWIEF REVIM I 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 1 have issued to me by the Iowa Department of Transportation a valid Driver's license number s.i6 Y 5° 2 �Z issued on 09 lo2 expiring on 101021/,6 . 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 Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on 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 date of Driver's license 1 6% 2//�iC�l 4' I wy < v 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. Signature of City Clerk or designee Datte ................................,.,..__,.....,..,......__._._,,....>......._..,,........,..........,,..,._..._.......yam, .....,...,...._.....:»,>. G 01 Office Use Only -v Approved application ( 0 DCI report �M ? t 6 State certified driving record .�." Website update aer NAXIDRIVBADGEAPPU2014am di .DOC 07/2016 e P. 9, 2U Ib 7;U)M Uiv o Criminal Investigation No, 2h94.. Y. 3 Fr_.... -S..._h_ Cl er.. 09/06/2016 12:L. .. Ees6 ...02/002 STATE OF IOWA Crfiainal iHlislury Record) Check F Request Form �5 � oiiV DCI AccountNwnber: 't-oo z -- (if applicable) To; Iowa Division of Criminal Investigation Suppnrt Operatlons.Bureau, I" Floor 215 r. 7'h Street Des Moines, Iowg 50319 (515)725-6066 (515)725-6080 Fox I am reontestlnrr, an Inwa rritninal I4 ictnry fl nr•.n.d ('LnnL From: Cita of IowaC� itI__ City Cleric's Office 410 E. Washington Slreet 101va CAL, YA 52240 Phone: 319-356-5041 Fqk; 319-356.5497 Last Name (mandatory) First Name (mandatory) Middle Name (recomnru,ded) -- k` Z A-1 n, ,1+- es A -D Date of Birth (/mandatory) Gender 'mandatory) Serial Seeuri Number (recommended) ®Female Waiver Information: without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of fowa, Chapter- 692.2. For complete criminal history record information, as allowed by law, always obtain a waiver signature from the sublect of the request. Wdiver.tleieH8e:1 Wetly givepemission for The abovo requesting official to conduct m lova criminal history record clmCIC with Tbo Division ol'Csiminal Invcnigetian (PCI). Any criminal history data coneenliag nnC that' sm IaineJ by the DCI may he released as allowed by Ion•, Waiver Signature: Iowa Criminal HistorV Record Check Results (u�'I use only)_' --1C_� As of 4 /�t �i 6 a search of the provided name and date of birth revealed: > No loilva Criminal History Record found With DCI t, cr Iowa Criminal History Record attached, DCI r' T DO initials._ ..L___ _ f�•1 DCI -77 (08/25/10), Received Time Si 6, 2016 12:34PM No. 339 C4A091% SMARTER I SIMPLER 1 CUSTOMER DRIVEN vvvvw.lowadot.gov Office of Driver Services PO Box 9204 1 Des Manes, IA 50306-9204 Phone: 515-244-9124 1 8OD-532-1121 I Pax: 515-239-1837 www.iowadot.gov Certified Abstract of Driving Record Inquiry Date: 9/2/2016 DL/ID #: 556YY2029 (IA) CDL Permit Class: None Customer #: 2663106 Class: D CDL Permit Issue None Date: Name: Kraina, Esad Audit #: 1275232 CDL Permit None Expiration Date: Address: 2651 WHISPERING Issue Date: 09/02/2016 CDL Permit None MEADOWS DR Endorsements: Expiration Date: 11/22/2018 CDL Permit None Restrictions: City/State: IOWA CITY, IA 52240 Endorsements: 3 ID Status: None Mailing 2651 WHISPERING Restrictions: NONE DL Status: VAL Address: MEADOWS DR Restriction None CDL Status: None Mailing IOWA CITY, IA 52240 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 11/22/1965 CDL Cert Status: None Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Kraina, Esad DL/ID: 556YY2029 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: ,`®a.;.......��'.•y01 9/2/2016 IOWA/l�' Nor*— _c Office of Driver Services 1 Iowa Department of Transportation Name: Kraina, Esad DL/ID: 556YY2029 '��r�� _' i•„t !