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Home My WebLink About12-125Fi st Middle Last �( ' 1. Name vv' -o � �� uqt �r c " ^ 1 2. Mailing Address I? GkCtM1�`/t'?ia C Cow0,rA,r r� 1—!�::2�(( 3. Telephone: Home 0 z Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? T� 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 years?eqfa Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? N o Type of offense Where When 8. Has your driver's license or chauffeurs 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) /1/ 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) 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) derWlaxidriWadg 0912040 ObI=U1�__ Authorization Number 12 - /2�) r 1 (Office Use Only) -4#t CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington Street between 8 a.m. to 3 p.m., Monday - Friday.) Iowa Ql ,Iowa 52240-1826 (319) 356-5040 ) (319) 356-5497 FAX Fi st Middle Last �( ' 1. Name vv' -o � �� uqt �r c " ^ 1 2. Mailing Address I? GkCtM1�`/t'?ia C Cow0,rA,r r� 1—!�::2�(( 3. Telephone: Home 0 z Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? T� 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 years?eqfa Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? N o Type of offense Where When 8. Has your driver's license or chauffeurs 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) /1/ 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) 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) derWlaxidriWadg 0912040 ObI=U1�__ I hereby certify 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 do may be n ed. 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'Mn w S L Date ( 2 1441!4111!lf14ft111N1N4f14}44fNifNl4N44N4N44N4N4441f4N1N41f 4f 4414 114!11 f 1f11N#i1Nff##4111!#1fNN1114f 414f#N1fft#1#N4MN4t#14NN STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by A 6 rood EIsk .c h � . On this /3-- day of 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). Signa re of Po a ie or designee Signhture of City Clerk or de ignee 7-1,?- t2, Date 7-/3-/,�2- Date NOT VALID UNTIL Police Chief and City Clerk have approved and authorized taxi driver names placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. 1Nl1NN#NIINNNNR#fN4'.tlf#4N#NlfiefflMIINNNNNf1Nl1NNNfl1NN4f#!f#1#N4NN#f##1fNlNN##fNf1N###N###!##N4##4!4#44N444Nf Office Use Only Approved application DCI report State certified driving record Website update d�a�2010.a OW2040 o�t2otZ 1u].12. 2012 10:35AM Div of Criminal Investigation J. LV 1 6 1. L71 1u 1 v I„ v I U 1 a v it r v 1 , unit V it STATE OF IOWA.r, f * &m1jum` '';•Criminal Historyr Check Request Form To 1. 1014 Division of Criminal Investigation Support Operations BUreAu, 1't Floor 215 E, 7"' Street Des Moines, Iowa 50319 (515) 725-6066 (515) 725-6080 Fax I em reouas6na an Iovra Criminal Hisfnry r7erro-d C6rnk m,• 1No.3 2x25 fP. X2/2 DCI Account Number; 40b I~ ' (1[oppllcabie) From: CITY OF XOWA CITY CITY CX.RUX'S OFFIM 410 R. WAgMNGTON STMOT IOWA CXTY IOWA 52240 Phone: 319-356-5041 Fax; 319-356-9491 XlaH1C IVamO (nlandslory) Fir9t N11016 (mandatory) Mddla Na1no (rwommcnded) lS -0, 1�h � 9\\y Aato of Birth (mandatory) Gender mandatory) Social isee"rity N'ulnher (tecommended) �G 7 y Er1Vlale O emale 7 Y,6 SLI Wrtiyel'-(f(fOYil/lti'ori: WlthoutasignedwaiverfromthesugJoetoftherequest,acomplete,criminalhistoryrecordmaynot ho releasable, per Code oflown, Chapter692.2. For com et criminal history record information, as allowed by law, always obtain awaIvor sl nafarefromfliDsubicctoftherequest WalverRelease; Itimby glVopcmllssion for above requesling oarctat to condnsl an Tows criminal his(ory record cllcckwith rhe Division otCriminel Inveadgation (DCI). Any almhrel lifilocy dela eonuming me that is mainiabred by the nClnmy be released as allowed by law. Waiver dlgnafar'ei_ � �q tvl-e_a 'N 1C 0, r-1 ?r Iowa Criminal History Record Check Results As of q-" CLO- , a search of the provided name and date of birth revealed: a- No Iowa Criminal Mstory Record found with DCI 0 .Iowa Criminal History Record attached, I)CI !k DCI initials/ Received Time7Jul. 9��2012 1:24PM No, 9173 (DC[pse only) I fj Iowa Department of Transportation N 6 Office ofDfiver5ervices 515-244-9124 PO Box 9204. ❑es Moines, IA 543(}6 92f34 FAX: 515234-1&37 Certified Abstract of Driving Record Inquiry Date: 6/28/2012 Issue Date: EI Sheikh, Ahmed Aly Name: Mohamed Date: 612 GRANDVIEW CT Address: None City/State: IOWA CITY, IA CDL Med 522463250 Mailing Address: 612 GRANDVIEW CT Mailing City/State: IOWA , IA DL/ID #: 147AC1919 (IA) Class: D Audit #: 6082684 Issue Date: 06/28/2012 Expiration 10/18/2017 Date: None Endorsements: 3 Restrictions: Corrective Lenses Date of Birth: 10/18/1974 Sex: M History Information CLEAR DRIVING RECORD Name: EI Sheikh, Ahmed Aly Mohamed DL/ID: 147AC3919 Customer #: 5267293 ID Status: None DL Status: VAL CDL Status: None CDL Cert None Status: Iowa Department of Transportation CDL Med None Status: 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. e seal of the Department to be set upon this document, at Ankeny, Iowa this In witness whereof, I have caused my signature and th date: Name: EI Sheikh, Ahmed Aly Mohamed DL/ID: 147AC1919 6/28/2012 IOWA . .Wi D. O.L;� 0%'•....�'SE�J' Office of Driver Services r„JRIYEQ+,-= Iowa Department of Transportation Name: EI Sheikh, Ahmed Aly Mohamed DL/ID: 147AC1919