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HomeMy WebLinkAbout12-0734 III cccccr-i b"CopgIl CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-SO40 (319) 356-5497 FAX First 1. Name Authorization Number. 1 ?) (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) rl�f�'✓�I /1/( Middle Last 2. Mailing Address I t � P AA n r - 1 r, "K i c r C 3. Telephone: Home ) / j —7a I 35 L`J L` Z Other: 4. Prior experience in transportation of passengers: Z2Y LA vs 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? !U D Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five A/ 6 years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? 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) V Qj 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) de. .dnwe g 09/2010 Y2 S,9% 9S 3/ I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 1 i 0- A l 3 I understand that if I falsely answer any questions in this application, that this application 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 Applicantl ;i Date Ci 2 `c �Z ###!##11111 flNlfNN##!#4Nf#NlfllfllffNN#NNNNfNI####N##fl#N####44#N#4#4f1N#####N####!###N#N#N#NlY##NF#f##N#N#####4f#}#4#}# STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by a n', ,r, I w a CLP -N- On this !!n day of March .90119 _.... Notary Public in and for the State of Iowa N1f#*******N4##4##t#iif111NN#M***#*i*#iN4YH#NYt#ii###111tf#fYt####*it##ittf#t##t#i#t#fi#iYt44tNY#iY###i##titYNYi*ititt#1t#iti##i##41#41 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). -15iignature of Police Chief or designee 3 /d -1.2— Date /,ZDate r�o3i Ii. 1 S e of City Clerk or designee Date After Police Chief 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 derkflexidnv gee p2010 d« 09/2010 TI Iowa Department of Transportation (TollFree) 515-244-1121 515-244-9124 Office of 204, Services FA)(_ 515-239-1837 PO Box 9204, Des Maines. IA 5030&9244 Certified Abstract of Driving Record Inquiry Date: 2/28/2012 Ghanim Malik Name: Alwaano 2532 BARTELT RD APT Address: 2C City/State: IOWA CITY, IA 522462720 Mailing Address: 25532 BARTELT RD APT Mailing City/State: IOWA CITY, IA convictions DL/ID #: 428AF9531(IA) Class: D Audit #: 4694775 Issue Date: 09/23/2010 Expiration 03/23/2015 Date: Endorsements: 3 Restrictions: NONE Data of Birth: 3/23/1965 Sex: M History Information tation Date Conviction Date ACD 09/27/2010 _ __ _S15 i/23/2030- _ ,___ - � M14 sn3/2011 06/22/2011 Customer #: 5542108 ID Status: None DL Status: VAL CDL Status: None CDL Cert None Status: CDL Med None Status: Restriction None Supplement: ,I'D Explanation v� IL Speed .. - 52 IA ffic Fall to Obey TraSign/Signal Name: Alwaan, Ghanim Malik DL/ID: 42SAF9531 do hereby of an the Director of the Iowa Department of Pursuant to Iowa Code §321 I am the .10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, Sal officialthat record currently in the custthe ody records econ saheld idoffice, by that I have hriver authorizedtbyt this Is a true and accurate copy certify of Transportation to so certify. caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa In witness whereof, I have this date: VtolbLr 0/(.j,, IOWA 2/28/2012 D.O.T.°y J pf .....•• S'vQ= Office of Driver Services Transportation Iowa Department of Name: Alwaan, Ghanim Malik DL/ID: 428AF9531 Mar. 8. 2012 11:56A Div Div of Criminal Investigation I. tv12 l.7J I' t,lty We(R — blty of 1OWa Wty .r 0 STATE (CDP ROWA Ocna9aaYaal.MstoryRecolyd Check Request.For 91 To; XOIVA1]Lvlsion6fGrlmltfa1XaVMtPgat(On Supp o1•t op¢rat(ons 13urozu,l't btooe 31$9. 7'"Sit6cE 1)oa"yilte9jTO1Va Sng19 (915) 725.6a66 (�1B)725-6090 iYe� No. 1078 P. 1/9 No, L 1 l8 r. L JaCTtl000unEN4lmher: �f60'].� �` ' ueapyu�no �) Frarar rLgv or, Tnr4A CTTY CITY CMK•9 OVICrs 410 x Msffll4C= 9TRRrx TOVA CITY T06YA, 52440 )A411 6T _ 319-456--5041 13'"'X1q�35s;--5497 NLwa(AY9 I �IhGN1M I Mo1L� 1{ 75aEoo Billih tmandn(urvl fiON (TeY /maudalnwl QnnFnl.4enYY1:4Kr 7�1VhiYrnnw_.. ,_. zap °3 — 23—) 0-( bl S— lie ro1611$ 1(o por Code Oxyd 6, I�14TaIe ' dl+"ernsle t Vt'atVey ilom thc,vubjoot of th®regtt 692.2 �or�nJrnloL'drlmfna]h)story • 3596692lc� 9 cotnpleteot7t4lnaLhisfaryTepoktYMAY11ot ord lnrofrmatlolr, as allowed 6�3 Law, afvrays }�l1t�VBY.IZB�BllS'8;!)lcfeby@fve permluLolr tbrlh0 nbov¢Yegh9sling dh10id1 to C9adNo(6n%Wa oi(mrna161s[orylrRord eheeklYl(I 1lanlisjaggeCrhnin6l Yoycytlaalfaa CDC)), +U,y at(olinelhfsrorydaW cogromingnlo 111M1aMolnlal¢W 6y IhepOrmey ba rchascd av nllowtd bylnN. d AUYVA-U C MILMA JL1. K(ay .C`T.CQ uzu U'Her'K.$`f,Pnd' U1L.H-i.�]Cj uD¢Onjy) As of � 1 O I �� , a aeotoh of ffioprovlded name end dato of birth•1•0Vealod: 1-� i r: DloXowaCxlulinaIHisto�y.kecoxd�oundwrlthDCT +-= ','• • © Xaws Odrainal mseory Record amehed, Del* r c nnT -w mor�5nn% Received Time 'Mar, 1. 2012 3:53PM No,0516