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Home My WebLink About16-219nwl®��il CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (319)356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. 16 —a/ I (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 Last 2. Address (REQUIRED) 25y5 CLEF1PWd3TER Coud2T IOWA �C-d it 5z'zq� 3. Contact Information (REQUIRED) Emai1:46J"-73@ Y4V1oco^Com Cell Phone: _319-L(dd-33`F2 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 03 - 2-0 20 I / b. Taxicab Business Name (REQUIRED) j-0 H N 10. ( \ utb 5. Prior experience in transportation of passengers: 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) N 0 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 -n 8 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? At O Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) No 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 h$reby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number ( %C? f�I}!, � issued on 5/4/2.16 expiring on o3/20lZo( ] 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, Cha ter 2, of the,Ci/t(jy�Code. (Needs to be signed in front of a Notary Public) Signature of Applicant ( �(1/*' Date Q - 2 q, ((a STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 0_Gt_N M A 0rr0 �k . E ft\ on this Z-9 day of WENDY 5.tE Notary Public in d for the tate of o My Comml •rrr ......e..r.....e...r+++..x+..e ...........re..r:...e..re.. 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 3 `" 1 Signature of Police ief o� nee 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. /V . Sig ture of City Clerk or designee �Yl aaraaaaaaa.aararaaa.aaraaa»araaaarrrraararamrrarrrrrrrrrrarrrr:rrrrrrrrrrrrrrrrr+rrrrrrrrmrrrrrrrrrr«rrrrrrr:rrrrrrrrar:r.rrrr:rrrrrr:rr» Office Use Only o v. cq Approved application 'o ; DCl report ry State certified driving record `O Website update Caen✓rnxiDRNBADGEAPPL92oiaamnded.Doc 07/2016 -I -. - .I. .,. ,,, .1:'0:11.1 1nVcZL16aIIV11 110.43L0 r. 1/12 Fl-m:Clay 01 IOWE Glly Clork 011106 31a 3666497 O6/13/20'IG 16:4a W67.1 Y.0 uaYo[12 ...;r. STATE OF �[�DV� S%A 1 r �� cv�r HOW IH sforry Reco rdl Chet I� To: Iowa Division of Criminal investigation Support Operations %beau, In Floor 215 F. 7" Street Des Wines, Iowa 50319 (515)725-6066 (515) 725-6080 Fax I all, requestink an E L 1 YE S o13 -2o - 10\-13 MKS AMooD DCI Acconut Number: Lf CJ 0 -a . (,- FIT , FITapplicablt) From: City of Iowa City City ClerIPs Elfltee 410 C. washin;to[I Street 10%va City, IA 522,40 Phone: 319.356-5041 Fax, 519-3565497 shSH IR UMaie OretDale 13 a ( 17- 0 5� 2 WadverYtzforntafion: without a signed waiver from the subject of the request, n comple[a criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For com lett criminal history record Information, as allowed by law, always Obtain a waiver signature from the subieet of the rrannef WaWk Release; 1 berebygivapennission for We above requcuing official to eond tI a,l Iowa eriminal hist 11100441110r, PCO, Any criminal llislory delaeon�eem/ifng mall al is mainmineQ by the Im/it'wa riminnl history yrecord ivedb Ialcheck with The Division ofclinitnal V. Yralver Sfgn(ititlrg; /� `� �--• L Iowa "L'IlC1ana ISO]* ]Record Cheek Iioesult- —� -- As o£_(�—�% , a search of tilem provided nae and date of birth revealed: 'A (nCl use only) e: Vi ® No Iowa Criminal History Record found with DCI 1 I ,,;.., I� Iowa Critrfinal History Record attached, DCI # DCI initials- —&—i n� . DCI -77 (09/25/10) RPrPivAd Timr. Se. n. 13. 2016 4:39pM hio.3890 `�NOWADOT SMARTER 15IMPLER I CUSTOMER DRIVEN www.iowadot.gov Inquiry Date: 9/28/2016 Customer #: 6005005 Office of Driver Services PO Box 9204 1 Des Mcines. IA 50306-9204 Phone: 515-244-91241 ODD -532-11211 Fax: 515-239-1837 www.iowadot.gov Certified Abstract of Driving Record DL/ID #: Class: Name: Eltyeb, Mahmood Bashir Audit #: 620AH7686 (IA) C 9980788 Address: 2545 CLEARWATER CT Issue Date: 05/04/2016 Expiration Date: 03/20/2017 City/State: IOWA CIN, IA 522464139 Endorsements: NONE Mailing 2545 CLEARWATER CT Restrictions: NONE Address: Restriction None Mailing IOWA CIN, IA 522464139 Supplement: City/State: Date of Birth: 3/20/1973 Sex: M History Information CLEAR DRIVING RECORD Name: Eltyeb, Mahmood Bashir DL/ID: 620AH7686 CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: `J�t CDL Permit None Endorsements: Office of Driver Services CDL Permit None Restrictions: 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, 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 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: ••.. %1' 9/28/2016 IOWA `J�t .."Poi rUAIVEN $ 8111111% Office of Driver Services k Iowa Department of Transportation Name: Eltyeb, Mahmood Bashir DL/ID: 620AH7686