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HomeMy WebLinkAbout12-043First Middle Last 1. Name m AaYlel 2. Mailing Address � - 3. Telephone: Home ) OA!:13 k1�' Other a"` )" z� l 4. Prior experience in transportation of passengers: r4 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? �n Type of offense Where When 6. Have you een convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? N Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? '%r'1 Tvoe 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) 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) GeNJtatitlnvbadg 09/2010 A)L — Authorization Number T3 l 1 (Office Use Only) �.�14AI CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 41 0 East Washington Street between 8 a.m. to 3 p.m., Monday — Friday.) Iowa Cit ,Iowa 52240-1826 t'9) 356-5040 0� � � (319) 356-5497 FAX First Middle Last 1. Name m AaYlel 2. Mailing Address � - 3. Telephone: Home ) OA!:13 k1�' Other a"` )" z� l 4. Prior experience in transportation of passengers: r4 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? �n Type of offense Where When 6. Have you een convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? N Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? '%r'1 Tvoe 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) 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) GeNJtatitlnvbadg 09/2010 hereby cerjify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number I understand that if I falsely answer any questions in this application, that this appli ion may be denied. I understand that if I falsely answer any of the questions in this application, that this application will 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 a license 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 Date Q .2 � 19 STATE OF IOWA ) COUNTY OF JOHNSON ) ( ( I jVtLt L y LGL r Wei T I n 8n this � ZI day of ribed and sworn to before me b I 0. PI h. i7Ya- �� � Si- Zo i Z Wf-CA CT_- K I u -i -f Public in and for the State of Iowa I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). -�/- is Date Date After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update cle Widnvbadgea 2010.dac 09/2010 Feb -17. 2012211:49AMN Div of Criminal Investigation; No.9553, P. 6/6 1V V, rVF.. vl t, V I G I A VILE VI 1UW(t Ully IVo. �Uyp r. L ut M I ! I O;O)F IOWA A ru4fhi; ( ;ISI M.to.. 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SIM.A,...ap.�w_.�-_A• lGtV2YPafg(ofk]1lcfcayglvaper/alq(ouAt[ho aboyeregeeslregonfAltorogdoo(M1a%Vacdmrnalhh+olyfWardcheokW ahIhebivrsfonorComfeor rnyosirgalfon (DCl], krW prrmrnelnlslory data doeamtrlgmolhultmalntolned6irlfroUO(mgy 6otefeayedaf al(olvad byla5v, As of oZ �) a ft sonvoh ofthapmvlded name and data of Wah•rovealeds 91 NO alwilluMstorYkecordfoltnd witltpCX rowa Orhninal liiator/ Record amohed, Del # DCS lr 101s t Received Time Feb. 13. 2012 8:39AM No.8890 (nCl via onb) cn Iowa Department of Transportation Office of Driver Services (Toll Free) 80032-1121 PO Bac 9204, Des Manes, IA 5030M204 515-244-9124 FAX: 515-239-1837 Inquiry Date: 2/14/2012 Name: Ibrahim Mohamed, Saifaldeln O Address: 2401 BARTELT RD APT 2C City/State: IOWA CITY, IA 522462701 Mailing Address: 2401 BARTELT RD APT 2C Mailing City/State: IOWA CITY, IA 522462701 Certified Abstract of Driving Record DL/ID #: 422AF7170 (IA) Class: D Audit #: 5748482 Issue Date: 01/19/2012 Expiration Date: 05/13/2015 Endorsements: 2 Restrictions: NONE Date of Birth: 5/13/1960 Sex: M History Information CLEAR DRIVING RECORD Name: Ibrahim Mohamed, Saifaldein O DL/ID: 422AF7170 Customer #: 5609235 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Pursuant to Iowa Code §321.10, I, Kim Snook, 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: Name: Ibrahim Mohamed, Saifaldein O DL/ID: 422AF7170 2/14/2012 IOWA D. 0. T.. pit......' gam, Vaal,—� Office of Driver Services Iowa Department of Transportation Name: Ibrahim Mohamed, Saifaldein O DL/ID: 422AF7170