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HomeMy WebLinkAbout17-108 IDENTIFICATION NO. '7—'0 r t (Office Us Only) ::III " go 1:17 APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday-Friday) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX First p Middle Last 1. Name (REQUIRED) h Awn 2 cJ\ S O s rnq►-1 2. Address (REQUIRED) -L 3 o a0r't42/I /Zol ` 1 r- Town Croy c -LV- 3. Contact Information (REQUIRED) Email: /-1-MahQ3 gm%n(-Con., Cell Phone:l3lC1)S/2-23 81 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) c,3 A 1 12c L L b. Taxicab Business Name (REQUIRED) fo t.JQ n 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 Tities3&)-4 A►. 4 C'7-C N r e .-i What happened to the charge?(Circle one) n --- f Convicted Dismissed Deferred Suspended Plead Guilty er x. 7. Have you been arrested/charged with any traffic offenses in the last five years? 35- v. Type of offense Where When ka "lo What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Vi () 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When _ /J U 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) /4d 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 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 9 Li 2 AL S Go S issued on(2;7//9/1c1.7 expiring on(53/1 i/2c"1-`1-- . 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, 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,,itle 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant V JDate e f 21/2c/� L STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 04o3 t.& .. ILA . D.S 0..4...zin this Z I day of u ryf" 7.c7/7. l � ,r WENDY S.MAYER S o Commission Number 729428 Notary Public in an r the State of Io ae�� My Commissionio _xpires jil. .ow "t"I 7 17 *********************ir***k********k*****************************************************************************A AAAAAk************************* 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). Expirati• date . D - license -3/ i i / 2 Z IL, . A if) Z li / ..7- Sign.ture •f Police i- •r designee Date c"'s AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN-IOWAZirY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. itstE `+ 7fr—4 GI Aram J� g"4-41— C9 / -fie(-le j �� Z/ai� 7 rn S gnature of City Cle 'or designee ^\ Date c:) �C o -• V1 CD ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update Glen TAXIDRNBADGEAPPL92014amended.DOC 07/2016 IOWA DOT SMARTER I SIMPLER I CUSTOMER DRIVEN WWW.iowadOt.gOv Office of Driver Services PO Box 92041 Des Moines,IA 50306-9204 Phone:515-244-9124 1800-5321121 I Fax:515-239-1837 www.iowadotgov Certified Abstract of Driving Record Inquiry 8/2/2017 DL/ID #: 942AL5605 (IA) CDL Permit Class: None Date: Customer#: 6409705 Class: D CDL Permit Issue None Date: Name: Osman, Mohamed Sharaf Audit#: 1979583 CDL Permit None Mahjoob Expiration Date: Address: 2530 BARTELT RD APT Issue Date: 07/19/2017 CDL Permit None 1D Endorsements: Expiration 03/11/2022 CDL Permit None Date: Restrictions: City/State: IOWA CITY, IA Endorsements: Chauffeur 3 ID Status: None 522462719 Mailing 2530 BARTELT RD APT Restrictions: NONE DL Status: VAL Address: 1D Restriction None CDL Status: None Mailing IOWA CITY, IA Supplement: CDL Permit ELG City/State: 522462719 Status: Date of 3/11/1981 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Osman, Mohamed Sharaf Mahjoob DL/ID: 942AL5605 (IA) 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, atnkeny, Iowa this date: L A..� �„v......y``1 C7-< rV /rob 1F ,,.....,•.#&#, is 8/2/2017 74 rin MI IOWA .s'% ' a. 'Ix a E...# • COI �*1�$I~ Iowae of Driver rtme terviTransportation CD Name:Osman, Mohamed Sharaf Mahjoob DL/ID: 942AL5605 (IA) Alig. 4. 2017 3: 03PM Div of Criminal Investigation No. 4244 P. 1/1 From:L:1[y O1 Iowa C:r1y Clerk 4aITlBo ssly s i oaio2/2017 11.0,3 w149 r.vvc/002 • . .tiyFluray STATE OF 110 W A 6..��:""" ,�« 5� � Crrinilinal Historiijy Record Check ,. , :r,, I V t , Reg1l es tl. Form yyyy�'''1(/4 n• �Pl DC) Aceouni Number: *L)o`a---- (if epplicoble) • 'Po: lovra Division of Criminal investigation From; City oflowa Citi•___._ _ ___ Support Operations Bureau,1"Floor City Cleric's Office 215 E. 711'Street 410 E.Washington Street Des Moines,Iowa 50319 -- _ (Si 25-60.66 lova Cit, , 14 522411 ,_ (515)725-6080 Fax Phone: 319-356-S041 Fax; 3)9-356-5497 -- 1,am re•ues(ing an Iowa Criminal History!Record Check on: _ Last Name (mandatary) First Name (mandatory) Middle Name(recommended) ------------- 0Sinati MbadmPC4 S ti u rq F Date of Birth (mondalory} Gender(mandatory) SocialSecurity securty Number(recommended) 03// 1 / iqs ! t. 'Iale 0 Female 2 _ q — ei '/ 6 Waiver information: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692.2.For complete criminal history record information,as allowed by law,always obtain a waiver si:nawre from the subicet of the request. --Wainer-Release:I hereby give permission for the above rcquestingofficiat•lo•conduct an Iowa criminal history record-check-with thc-DiviSion of Criminal —-- Investigation(DCI). Any criminal history data concerningJi iSal issmaintained by the DCI mey be released as allowed by law, Waiver Signature: _ • Iowa Criminal History Record Check Results © (Dertri only) As of___qa search of the provided name and date of birth revealed: �,,"'tG-3 foie, ‹ t O r. .....,, elirNo Iowa Criminal history Record found with)?CZ m 673 0 ;py • cit • • 0 Iowa Criminal History Record attached, Da# t -tom • DCI initials %dr .•-. DCI-77 (08/25/10) Received Time Aug. 2. 2017 10: 37AM No. 3972