The URL can be used to link to this page

Home My WebLink About17-148r CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. j11 [ j5 ((Jffic4 Use'vnly) APPLICATION FOR TAXICAB / MFUL9 IQDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) 20 11 OCT 31 AM 10: 46 ;o( C YU 3. Contact Information (REQUIRED) Email: n (All v CITY CLEF; i'cw #$ IC l �l Q—m4ct( -ccti l n communication sent via email) LI lorv�t cfXr/ 1 A r22 is Cell Phone: 703 - 4a. Driver's License expiration date (REQUIRED) It 2 3 / 7 p f } b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: C t9� C6$� f cw l cL.�Yj 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? rjc7 Type of offense Where When 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? /� 0 Type of offense Where When 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? hf� Type of offense W here When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) /J O 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 1 have issued to me by the Iowa Department of Transport tier1 v id iver's license number �e� 6 p issued on I 1 Z ti 1 z� 4expiring on i� 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 ed�aam' aDy pd all records and documents relating to this application, and I further agree that, if authorization to b��1�%�be iv s a , 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�.-3 ct&t e ` 1 I L Date I u. STATE OF IOWA ) COUNTY OF JOHNSON ) bsc ibe anGd sworn before me by 1 1 b II /oon�HTIs 5� day of 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 ( (K Z� Signature of Pot a ief o designee 19;` Z2 _ v 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. Sighature of City Clerk designee Date Office Use Only Approved application DCI report State certified driving record Website update CWKITMIDRIVBADGEAPP 92014am ded.DOC 07/2016 -1,.2,Yrn1nOforv,v of rlminai invest gal ion No. 4162rxa� P. 1/9 "' • •- ••�-_--, 10/24/2017 10:x.., _71002 FILED IS'I'AM' OF IOWA Crfi) dual History Record ChJ;Jt! OCT 31 A Request li'orm'— t. t i (i Gi_.- 'to! Iowa Division of Criminal Investigation Support Operatlons uuretlu, In Floor 215 E, V street Des A1oloes, Iowa 50319 (51$) 7Z5-6066 (515) 725-6080 Fax on; DO Aceounl Number; ' r cicia 4Z til aVVl"Tic From: City oflowA Ciiv City ClerlesOff e 410 Ps�Washington Street Iowalowa City, �0 Phalle; 319-356-5041 1738: 319-356.5497 �l �FIAH1=1CL1)jN I 11119 HA AH MLO Date of iiirtls (mana9m y) Gender manaaw) Social Security Number i¢eommeaa9t i Z,3 1 3 Male ❑Female 2 2 9—��_ WttipeY lnform(lliorc: Without a signed waiver from tine subject of the request, a complete criminal history record may not be taro Mesolithic, per Code of from, Chapter t of For, nest, elIt criminal history record information, as allowed bylaw, always Obtain a waiver signature from the sub ect of the request, I/ (liver Aeleuse: t borebw mire ocnnisslnn tnnn.. nhnvn ,.qn-.nen,r!',d,l 1. .,p,pd .n I." pn,,,nur qj,{y„ ,pg„u w,yK x4m me u�Ws�on orcrinlinnl hlv9sligatioa (DCI), My criminal history dela continuing nu niml it m9 inIbibad by 1119 DCl In 4y be rel use a u alloweabylaw. I r Iowa Crimory Record Check Results As of - �—) a search (DCI use only) , of the provided name and date of birth revealed: �No lowa Criminal History Record found with DC) 1' Z4 ❑ Iowa Criminal History Record attached 1)CI F in . y ®°*-+ DO initials t:721 ^' r rn n !moo DCI -77 (08/25/10) J Received Time Oct, 24. 2017 10:37AM No, 4493 A 'ARTS C44101"00T FILED C, SMARTER I SIMPLER I CUSTOMER D1211�iD•0tg0V - Page 1 of 2 I xy7.. Office of Driver Services Y6IlG#j�pay Des Moines, IA 50306-92{4 Phone: $L51.I-ylg� i:800r592-1121 I Fax: 515-239-1837 www.lDwadol.gov History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date IUR Case Number 26 01/22/2014 ....IIA 7813 -._. 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: '••'•••��"4 10/31/2017 Certified Abstract of Driving Record Inquiry 10/31/2017 DL/ID #: 596AH4569 (IA) CDL Permit Class: None Date: Customer 5955498 Class: D CDL Permit Issue None #: Date: Name: Algaall, Bahaeldin Audit #: 2254783 CDL Permit None Akasha Expiration Date: Address: 801 CROSS PARK AVE Issue Date: 10/24/2017 CDL Permit None APT 1C Endorsements: Expiration 10/23/2025 CDL Permit None Date: Restrictions: City/State: IOWA CITY, IA Endorsements: Chauffeur 3 ID Status: None 522404491 Mailing 801 CROSS PARK AVE Restrictions: NONE DL Status: VAL Address: APT 1C Restriction None CDL Status: None Mailing IOWA CITY, IA Supplement: CDL Permit ELG City/State: 522404491 Status: Date of 10/23/1973 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date IUR Case Number 26 01/22/2014 ....IIA 7813 -._. 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: '••'•••��"4 10/31/2017 f BBIYtI Office of Driver Services Iowa Department of Transportation http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 10/31/2017 'ARTS 11 Name: Algaali, Sahaeldin Akasha DL/ID: 596AH4569 (IA) Page 2 of 2 F ILELD 781701731 AM 10: 48 CITY CLERK !C'AVA CITY, IOWA http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord.aspx 10/31/2017