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HomeMy WebLinkAbout17-147� r 1 CITY F IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1 2. 3. IDENTIFICATION NO. J `? — j (Office Use Only) APPLICATION FOR TAXICAB 1 MOLPEE&EDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) Name (REQUIRED) 8 N AELI) I N Address (REQUIRED) so( C>Ya Contact Information (REQUIRED) Email: n (All v IOWA CITCYE��r;, eCwK C tk # I C JV iA Yzzyo c -L1 C&� 6014,C-c.o'v'l Cell Phone: 703 n communication sent via email) 4a. Driver's License expiration date (REQUIRED) J* 23 1 7 C/ + pp b. Taxicab Business Name (REQUIRED) Cj-� GAb 4 toa.0 C°"1 5. Prior experience in transportation of passengers: (-t" �-A 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? `D Type of offense Where When ►7 A What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? /Ja Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 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) I`f b 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 D ' r' li umber ,Sq (� Fl q issued on I�/2H /zol4expiring on 11/23�jo1't<. �r&r 2n hat 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 exarrl. bay Zd'aoll records and documents relating to this application, and I further agree that, if authorization to be a taxicab driv spy hall 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) /� p CITY CLERK Signature of Applicant 1,340'4'"-&te Date Io1 ��� IOWA CITY.10WA STATE OF IOWA ) COUNTY OF JOHNSON ) bsc ibe and sworn before me by AQaIllt I on MsJ S� day of CHRISTINE OLNEY Notary PulA in and or the Stat of owa z � � f ######IFf####*H*#Yt#######»#»#»#»fe#RR#»#f------##############1tl#ft##ltftfe####frR###tM#fF####!f##i#f(######Y####» 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 I0' z3 Z� Signature of Poi a ief of designee 1 0110-ov 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. /a��f A 7 Sigiiature of City Clerk qf designee Date Office Use Only Approved application DCI report State certified driving record Website update aeA/rAXIDRNa4DGEAPPL92014am ded.DOC 07/2016 I 201Z,9A7AM Div of Criminal Investigation No. 4762 P. 1/9 ._ Gl er.. ......... --- ..-- -_-I 10/2A/2017 10:L_ !26•_ i/o0. FILED ,.:. ,STATE, OF 1OVVA �I1t�CT 31 AMI Y � C' ftninai History Recom diect� ' Request )oor1v1 CITY CLQ 'to: Iowa Division of Criminal Investigation Support Opern(Ions bureau, l" Floor 215 C, 7" Street Des Wines, Iowa 50319 (515)725-6066 (515) 7x5-6000 Fax an Air 6') ic1A L 1 101231 i9 -f3 Check 1311Hill cL1) 1N DCI Accnani Number: ' ( DDa (ifopplieflbla) From: —9LN oflowa City City Clerle's Office 410 1,7. W.Rshington S(rcet rows cit , 1A 52240 Phone; 319-356-5011 ),as: 319-35CS497 —" Male ❑Female AVilsHAAHMLO 22.L1— 91 _ 17S9 Waiver Injormalion: Without a signed waiver from the subJect of the request, a complete criminal history record may not be releasable, per Code of (owes Chapter 02.2, Fol- cotnaiete criminal history record information, as allowed bylaw, allveys obtain a waiver signature from the sublect of the request. Wa/per Release; I h1r9bv afire oenniuicn fnr me ohnvn •• I, ,,114061 „ r,.., .a,nrn.t n;.w,y ,cww WIM with ihr omslon orcriminhl hwestipafion(DCIJ My criminal hislory dela coneendng me Ilial ty msinlaMed by the DO may be refused as abased by taw, Iowa Criminal History Record Checic Results (DCI use only) As of a��� a search of the provided name and date of birth revealed: *"�No Iowa Criminal History Record found with DO 13Iowa Criminal History Record attached, DCI #! Fri C: (n +: _ n '" y V1 ©rn DCI initialsZAC,— —I ri N r �n do DCI -77 (08/25/10) —r•_ J Received Time Oct, 24. 2017 10:37AM No, 4493 ARTS Page 1 of 2 �J10W DOT FI SMARTER I SIMPLER I CUSTOMER DRIVEN d Ve Office of Driver Services PO Box 92041 50306-9204 Phone: 515-244-91241 1 a(C, 5,239-7837 vwi .61adol.gov Inquiry 10/31/2017 Date: 801 CROSS PARK AVE Customer 5955498 Mailing IOWA CITY, IA Name: Algaali, Bahaeldin Date of Akasha Address: 801 CROSS PARK AVE Sex: APT 1C City/State: IOWA CITY, IA Certified Abstract of Driving Record DL/ID #: 596AH4569 (IA) CDL Permit Class: None Class: 522404491 Mailing 801 CROSS PARK AVE Address: APT 1C Mailing IOWA CITY, IA City/State: 522404491 Date of 10/23/1973 Birth: Sex: M Certified Abstract of Driving Record DL/ID #: 596AH4569 (IA) CDL Permit Class: None Class: D CDL Permit Issue None g Date: Office of Driver Services Audit #: 2254783 CDL Permit None Expiration Date: Issue Date: 10/24/2017 CDL Permit None Endorsements: Expiration 10/23/2025 CDL Permit None Date: Restrictions: Endorsements: Chauffeur ID Status: None Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date JUR Case Number 01/22/2014 iIA :781326 Name: Algaali, Bahaeldin Akasha DL/ID: 596AH4569 (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, at Ankeny, Iowa this date: ?.•"""• �0"4�� 10/31/2017 IOWA D. 0. T.€ g ... ... $ _ Office of Driver Services Iowa Department of Transportation http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 10/31/2017 ARTS Page 2 of 2 Name: Algaali, Bahaeldin Akasha Dl/ID: 596AH4569 (IA), 1 L F_. N17 OCT 31 AM 1C� it ` CITY C;LEH IOWA CITY, 10t��D http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 10/31/2017