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Home My WebLink About17-012CITY OF IOWA CITY 410 East Washington Strecl Iowa City, Iowa 5 22 40-1 82 6 (319)356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. /—jZ —Z7� (OfficeUse 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 3. Contact Information (REQUIRED) Email: 1 4a. Driver's License expiration date (REQUIRED) OZ- (g . 2, J )] b. Taxicab Business Name (REQUIRED) d OINC1t1 I4i(t 5. Prior experience in transportation of passengers: L- A- 5-2246 11[14,( Ct", Cell Phone: 93.7-X02(0- Io -33 n sent via email) �J 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State,greiseva-Fiere? Type of offense Where =..W` fin � �. . _s D 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? r Type of offense Where When J /�- 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? 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) 140 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) mew( 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number / 36 A M q 20-7 issued on 01.1 -2o I', expiring on 02-18'- 2017 . 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 �,J Date 01 STATE OF IOWA ) COUNTY OF JOHNSON ) ktv Subscribed and sworn to before me byTbr-4tnc�., '(`!� � \• � � on this a� day of Notary lic in and for th State o owa � 3 ("7 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 OI,5� 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. Signatyre of City Clerk or designee D Cleh./rAXIDRIVBADGEAWL92014amendW.DOC 07/2016 Office Use Only. {C7 - r" 1171 Approved application_ N DCI report n State certified driving record Website update Cleh./rAXIDRIVBADGEAWL92014amendW.DOC 07/2016 �' 4 b DoT SMARTER 1 SIMPLER I CUSTOMER DRIVEN wwwkwadotgov Office of Driver Services PO Box 9204 1 Des Moines. IA 59306-9204 Phone: 515-244-9124 1 800-532-1121 I Fax: 515-239-1837 www.iowadoLgov Certified Abstract of Driving Record Inquiry Date: 1/27/2017 DL/ID #: 136AM9207 (IA) Customer #: 6557997 Class: D Name: Salih, Ibrahim Mohamed Audit #: 1558654 Address: 2355 JESSUP CIR Issue Date: 01/19/2017 CDL Status: None Expiration Date: 07/15/2024 City/State: IOWA CITY, IA 522461715 Endorsements: 3 Mailing 2355 JESSUP CIR Restrictions: NONE Address: Restriction None Mailing IOWA CITY, IA 522461715 Supplement: City/State: Date of Birth: 7/15/1979 Sex: M History Information CLEAR DRIVING RECORD Name: Salih, Ibrahim Mohamed DL/ID: 136AM9207 CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: yw J�P i, 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: :.•""••:"'A "p 1/27/2017 IOWA ?' D. 0. T. ' � yw J�P i, f OAIYEt•� Office of Driver Services Iowa Department of Transportation Name: Salih, Ibrahim Mohamed DL/ID: 136AM9207 State of Iowa Division of Criminal Investigation 215 E. 7a' Street Des Moines, Iowa 50319 Phone: 515/725-6066 Fax: 515/725-6080 Iowa Criminal History Record Check Walk -In Request Your name za 611, Address: SJ' JW c(L City/State ZiW CI T 22 Kv Phone #: q37- 624-1031 MO//AMED Requesting an Iowa criminal history record check on: Fill in all shaded areas. Last Name Apellido (mandatory) First Name Primer Nombre (mandatary) Middle Name Segundo Nombre (recommended) S PL r-ff -1&974NiIV MO//AMED Date of Birth Fecha Nacintienio (mandatory) Gender cenero.(mndatory) Social Security Number (recommended) 07 /S_ 197 q eMale ❑ Female Waiver Signature Firma (If the request is on yourself, please sign. If the request is on someone else, write N/A.) OC1 USE ONLY Resul As of , a name and date of birth check revealed: `_ . r. %No record found r� = —+ ❑ Record attached DCI # DCI initials iV :n Receipt Number of requests ( x $15.00 per last name = Total amount $ 5 , C) D Method of payment: _ cash money order check # MasterCard or Visa (Last 4 digits) Cardholder's name DCI initials ------------------------ ------------------------------------------------------------------------------------------------------------------ Credit Card # Exp. Date DCI -83 (09/09/ 10; Revised 10/ 1/ 10; form reviewed 08/11/14)