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Home My WebLink About16-216� r I CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319( 3S6-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. 2 LO— Z-11 fJ (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_m Mid Last . / 7 ,lea � y rol 3. Contact Information (REQUIRED) Email: 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) kC ;4 Y,) /G /aWcx jAh22-4 4lnit—%Cod Ahea • 16 Cell Phone: 0 5 written communication sent via email) ns-/ � gZ202-0 TO via l,1 Tac I- Ca h 5. Prior experience in transportation of passengers: yes, / 6,5rr Ie a I- driver 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere G S Type of offense What happened to the charge? (Circle one) Where lewa 6 o r/7Jv/Z Convicted DismissedDeferrer Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? A/6 Type of offense What happened to the charge? (Circle one) Where When 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? NO Type of offense Where When N O 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide th�lame(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFaED 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 1 have issued to me by the Iowa Department of Transportation a va id Driver's license number LF 2 f /4 F-53 75- issued on 05/1ML expiring on o5AZI 2oza 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,j9f the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant�L Date ° %/Z 9 Z a 16 STATE OF IOWA ) COUNTY OF JOHNSON ) 2bscribed any sworn to before me by }fit ilSb g_ftnl I Yl.- D . 14citA r cO on this Z 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). Ws license Imo' U V or designee Dat 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 Date N O rn cn . n, Office Use Only f v - tD Approved application ' b DCI report - y State certified driving record Website update ClerkJTMIDRIVBADGE PPL92014ameided.DOC 07/2016 F ro m�ClcY sf lows CIIY CI Brk Off Ice 91B 96664BJ' Da/24/2016 12;00 4642 P,002/002 STATE OF IOWA Criminal History Recgy,d Check @ Request Form' To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 E. 7'h Street Des Moines, Iowa 50319 (515)725-6066 (515)725.60@0 Fax T sin remieetino an TnwA Criminal T-lkmw Rennrd ChnA - n, I j:2yi.oe� . DCT Account Number: 4Jnn Z r� (if applicable) From: City of Iowa City City Cleric's Office 410 E. Washington Street Iowa City, IA 52240 Phone; 319-356-5041 Fax: 319.356.5497 Last Name (mandatory) First Name (mandalory) Middle Name (recommended) / /-7� rn / � ' /7,17 t/ Date of iiirth (meodatory) Gender mandatory) Social Security Number(recommended) 0 5 /� % 75 I�NXaIc ❑Female l� �} T 7a 47 9!O Waiver Information. Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of lova, Chapter 692.2. For complete criminal history record Information, as allowed by laiv, always obtain a waiver sivnalore from the subject of the request. Waiver RCIeUSe: l Nrtby give pcnnilsion for the above requesting official to conduct nn Iowa efiminal History retard check with the Division orCriminal Investigation (DCI). Any eliminal history date concerning jilt that is meintaiacd by the DCI may, be released AS allowed by lase. Waiversignatare: t eQ( Iowa Criminal History ]Record Check ][results pollue only) As of _ e3 a search of the provided name and date of birth revealed: . m ,1 cn . ❑ No Iowa Criminal History Record found with DCI' y J 9b15o� r Iowa Criminal history Record attached, DCI #t ' crl DCI initials o,..:...1 T:_./fa.:. std ontr 11,a]Aee el- nC11L IOWA CRIMINAL HISTORY NON CONVICTION DCI 00961507 PAGE 1 OF 1 DATE PRINTED- DCI:00961507 2016/06/30 NAME: HAMID,HUSHAM HASHIM MOHAMED DOB SEX RAC HGT WOT EYE HAIR SKN POB 19750510 M U _ 511 210 BRO BLK MBR YY ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 20120725 AGENCY: IAOS20200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA700,2A(2)(B) DOMESTIC ABUSE ASSAULT CAUSE BODILY INJURY/MENTL ILLNSS TRK#; 1A00ESY01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA700.2A(2)(B) DOMESTIC ABUSE ASSAULT CAUSE BODILY INJURY/MENTL ILLNSS(SRNS COURT CASE ID: 06521 SROR098629 CHARGE CLASS: NON CONVICTION TRK#: 1A00ESY01 RESTITUTION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20121119 PROBATION lY 20121119 UNSUPERVISED PROBATION, INFORMAL PROBATION REVIEW 06/01/13 DISCHARGEb FROM 20130903 DEFERRED JUDGEMENT AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA'DIVISION OP 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 \ wu. L7 IL r. 9/4 ARTS C4410WADOT www.iowadot.gov SMARTER 1 SIMPLER I CUSTOMER DRIVEN Inquiry Date: Customer Name: Address: 9/29/2016 5612203 Page 1 of 2 Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone. 515-244-9124 800-532-1121[Fax: 515-239-1837 Www .iowadolgov Certified Abstract of Driving Record DL/ID #: 424AF5395 (IA) CDL Permit Class: None Class: D Hamid, Husham Hashim Audit #: Mohamed Osman 2530 BARTELT RD APT Issue Date: 1C City/State: IOWA CITY, IA 522462719 Mailing 2530 BARTELT RD APT Address: 1C Mailing IOWA CITY, IA City/State: 522462719 Date of 5/18/1975 Birth: Sex: M 9076798 05/12/2015 Expiration 05/18/2020 Date: Endorsements: 3 CDL Permit Issue None Date: CDL Permit None Expiration Date: Restriction None CDL Permit None Endorsements: CDL Permit None Restrictions: ELG ID Status: None Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: rn vu!cu. R•'• � 4� `? CDL Permit ELG IOWA Status: r D.O.Ty CDL Cert Status: None AA CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Hamid, Husham Hashim Mohamed Osman DL/ID: 424AF5395 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: Name: Hamid, Husham Hashim Mohamed Osman DL/ID: 424AF5395 http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 9/29/2016 r—� 0 rn u rn vu!cu. R•'• � 4� `? 9/29/2016 o IOWA r D.O.Ty .P.w 'a AA Office of Driver Services �a.+c Iowa Department of Transportation Name: Hamid, Husham Hashim Mohamed Osman DL/ID: 424AF5395 http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 9/29/2016