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HomeMy WebLinkAbout16-215it r I �'t.✓)is_ lull CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319) 3S6-5040 (319) 3S6-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. 1 (D — (2,l `) (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 ��LOI,, Middle �d1�j pLast�,��� K CA Ur' C'..St '1 1. )/ Y) S Dk "t eV ,2 %l�CU4�lh� . �rlrarr h 77 r`i(_ 3. Contact Information (REQUIRED) Email: 4a. Driver's License expiration date (REQ[ b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa LA o Ci jr" Cell Phone: `7196 sent via email) 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? _ A16 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? Alei Type of offense Where When What happened to the charge? (Circle one) N Convicted Dismissed Deferred Suspended Plead Guilty.. OttW 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? i='n/1/ff Tvoe of offense Where r- W herf\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 �f�f�e y 'ty that I ave issued to /me by the Iowa Depa ant of Transporta'on a valid Driver's license number itYJ�e nyylC�,t�--tfL//}t�/)' issued on expiring on Qj 101 7-07A 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 tt: YJ �Q-� i12� V'�-- Date STATE OF IOWA ) COUNTY OF JOHNSON ) bscribed and sworn Q 1before me by -O IP jkbdeI ko-� rviL� GLC i 0 0-,r2� in and on this C�f ' l ` day of 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). (tI z ►t date of7e e license �, 9 V f Police Chie 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. Signa re of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update IF/A ?/o Date C-1) rD Ge,wrnwDw g3ADG nPP02014amended.DOC 07/2016 r,.,ry :lty of low. L:ley clork 9tliee 319 3666697 Ola/16/2015 "13:55 STATEOF IOWA Criminal i 1.rd Check 18,11 Request 'Co: Iowa Division of Criminal Invostigation Support operat(ons Bureau, V Floor 215 r. It' Street Des Molnes, Iowa 50319 (51S) 725-6066 (515) 725-6080 Fax 1 am reouestino an Iowa Criminal FTictmv Record C6ecle nn, 467E P.D02/002 DCl Aet:ount Numbev; (ifapplieable) From: City of Iowa Chit City Cleric's Office 410 B. Washin ton Street Iowa City, IA 52240 Phone: 319-356.5041 Fax., 319-356.5497 Last Name (mandatory) First Name (inandamry) _Middle Name (recommended) A l t`_ 44arriI.-eJ i4bde 1vvL limctr 1 4daUA Date of Birth (mandemCy) (Gender 0nmaotory) Social Securi Number (ncoremellded) ©4I Or I I `6d male [Female 670093dgz li/aiver Information: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chaplet- 692.2, For complete criminal history record information, as allowed by law, always obtain a waiver si nature from the suNect of the request, Wa iVCr Release; 1 hereby sive pWmission for the above requesting official to conduct on lows uiminal history record check with the Division orcrilninal Investigation (DC). Any criminal history dela contenting me that is tnaimaincd by the DCI may he released as allowed bylaw. Waiver Signature: � �J YI�_rt � u Iowa Criminal History _Record Check Results ()Cl use only) As of a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCT lova Criminal History Record attached, DCT # ✓ " G c., �. '. 1, DCl initials_ _ )JCI -77 (08/25/10) Received Time Seo, 16. 2016 1:41PM @o.4131 ;k(UVUA00T wwwkwadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1 ODD -532-1121 I Fax: 515-239-1837 W W W.fowadol-gOV Certified Abstract of Driving Record Inquiry Date: 9/24/2016 DL/ID #: Customer #i 6534984 Class: Name: All Named, Abdelrahman Abdalla Audit #: Address: 808 WESTWINDS OR APT 2 Issue Data: City/State: IOWA CITY, IA 522464027 Mailing Address: BOB WESTWINDS DR An 2 Mailing IOWA CITY, IA 522464027 City/State: Date of Birth: 1/1/1960 Sex: M Expiration Date: Endorsements: Restrictions: Restriction Supplement: Name: All Harrod, Abdelrahman Abdalla DL/ID: 123AM6126 123AM6126 (IA) D 1236126 08/17/2016 01/01/2021 2 NONE None History Information CLEAR DRIVING RECORD CDL Permit Class: CDL Permit Issue Date: CDL Permit Expiration Date: CDL Permit Endorsements: CDL Permit Restrictions: ID Status: DL Status: CDL Status: CDL Permit Status: CDL Cert Status: CDL Med Status: None None None None None None VAL None ELG None None Pursuant to Iowa Code 4321.10, 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: . 9/24/2016 IOrpr^ II. •24D. Y'4� %% ......•eo f Office of Driver Services 'lyDolm, Iowa Department of Transportation Name: Ali Hamed, Abdelrahman Abdalla DL/ID: 123AM6126