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Home My WebLink About16-213CITY OF IOWA CITY 410 East Washington St reel Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) - 2. Address (REQUIRED) IDENTIFICATION NO. I p — 21 (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 444° Middle A/dlc, Last,�f, f 3. Contact Information (REQUIRED) Email: eW q CFZI (U ji»aCA i CC)fN Cell Phone: ''S LS y uCj2 (All written commuri cation sent via email) 4a. Driver's License expiration date (REQUIRED) _ b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: 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 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? _/y/ Type of offense Where When 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? Ile) Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty_ N OttFF 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five:year5? ,``41" > Type of offense Where WherN ---7w.3 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 e y e ty that I ave issu d to me by the Iowa Depa ent of Transporta'on a valid Driver's license number ��1Gf� �� issued on �(2expiring on o�y`!A . 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 ^ ,l�Y�n�1LpV_�- Date STATE OF IOWA ) COUNTY OF JOHNSON ) Abd e I }Za-l1 vKa-v�-, �, { �3obscribed and sworn tp before me by �� Ia))r1 on this l ' V v day of �O.404e v1n ( I W so _ KFLLIE K. FRUEHLING 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). date of.DrWerN license Z Ir 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. /llRu�r./ -e - Zee el r% SIgnature of City Clerk or designee Date r•a 0 Office Use Only Approved application N DCI report co r State certified driving record Website update C.3 r1 CeMRAXIDRN64DGEAPPL92014ame.ded.DOC 07=16 ... . Fra m:u ty mr rowm Cloy Clerk r?ff Ice 319 9666497 Oa/la/zola lana 067ts P.002/002 fpor, u� STATE O,l IOWA G�eL� Criminal i. IRecord Check Request Yorm �owa y To: Iowa Division of Criminal Investigation Support Operations Bureau, P Floor 215 L. 7" Street Des Molnes, Iowa 50319 (515) 725-6066 (515) 725-6050 rax I gill repuestino an lnwa uo.,,..a 1`11—A, ..... DCT Account Number; _ 4i orj Z, (irapplicable) From: Cib of Iowa City __ City Clerk's Office 410 C. Washington Street Iowa City, 1A 52240 Phone: 319.356.$041 Fax: 319-356-5497 _Last Name (,nandatory) First Name (nimdalory) Middle Name (recommended) d I - arr�z.� �4bde_Im-kMoLr) �bd� Date of Birth (mandesory) (vender (mimidatory) Social Securi Number (recommended) ( C) (J ea 60 male ❑Female 70 09 3(5Lt Z 91'aiver 100rnta6011: WI(hout a slgned waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapler 692.2, For complete criminal history record information, as allowed bylaw, always obtain a Waiver signature from the subject of the request, Ilrat per Re%aSe; 1 hereby give paonission for the above requesting amefal to conduct an Imvo crlininot history record check: with the Division of Crinsival Invcslieas(on (DCO. Any criminal history dale cmlcerning me Thal is maimpined by the DCI may be released os allowed by ctw. Waiver Signature: A,kde 6 Iowa Criminal Histor Record Check Results As of Q—Z.(-w , a search of the provided name and date of birth revealed; No Iowa Criminal History Record found with DCI Iowa Criminal History Record attached, DCI # DCI initials_ , DCI -77 (US/25/10) Received Time Sep. 16. 2016 HIPM @o.4131 (DCI mcoilty) 1 RUWADOT SMARTER I SIMPLER I CUSTOMER DRIVEN VVWW'IOWBCIOt.gOV Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-1121 1 Fax: 515-239-1837 www_iowadct.gov Certified Abstract of Driving Record Inquiry Date: 9/24/2016 DL/ID #: Customer #: 6534984 Class: Name: All Hamed, Abdelrahman Abdalla Audit #: Address: 808 WESfWINDS DR APT 2 Issue Data: City/State: IOWA CITY, IA 522464027 Mailing Address: 808 WESTWINDS DRAPT2 Mailing IOWA CITY, IA 522464027 City/State: Date of Birth: 1/1/1960 Sex: M 123AM6126 (IA) D 1236126 08/17/2016 Expiration Date: 01/01/2021 Endorsements: 2 Restrictions: NONE Restriction None Supplement: None History Information CLEAR DRIVING RECORD Name: All Named, Abdelrahman Abdalla DL/ID: 123AM6126 CDL Permit Class: None CDL Permit Issue Date: None CDL Permit Expiration None Date: CDL Permit None Endorsements: Iowa Department of Transportation CDL Permit Restrictions: None 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, 1, 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: '• �iPj40 9/24/2016 IOWA•'�z'o fr; �A1A S ; Office of Driver Services cyI Iowa Department of Transportation Name: Ali Hamed, Abdelrahman Abdalla DL/ID: 123AM6126