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Home My WebLink About12-1467. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When ✓-�;c /SP� i ��;� k. *ML WV'p-ttc rd 4k C)V 6�S CVciccs /A%J C-l';\c) B. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? Y*' Type of offense Where SUSQC-du��'t SbitC`4t ., .'>\e.�rav Tv..JA L%vr When o9 9. Have you ever applied to bean 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) de�dri�.dg 09/2010 Authorization Number I -�_ — I % 1 (Office Use Only) �tJ4_ 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 City. Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX First Middle Last tA� 1. Name �1T�Cc0aT l� 11,rIn1'EH 2. Mailing Address 3. Telephone: Home 3\5 3s\ \$32 Other. (oo\ (o o 3 a 4. Prior experience in transportation of passengers: y q--� r Or J "^t 'c'4-X l tl"'_') d 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Yc S Tyne of offense Where When N jacK%,>v.a4 c> -T 2s�yr1 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? tA D Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When ✓-�;c /SP� i ��;� k. *ML WV'p-ttc rd 4k C)V 6�S CVciccs /A%J C-l';\c) B. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? Y*' Type of offense Where SUSQC-du��'t SbitC`4t ., .'>\e.�rav Tv..JA L%vr When o9 9. Have you ever applied to bean 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) de�dri�.dg 09/2010 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number qss Y A 'i c ) -i� . 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) I Signature ofApplic Date STATE OF IOWA ) COUNTY OF JOHNSON ) Su cribed and sworn oo before �a me by A On this Zr—�d ay of KELLIE K. TUTTLE Notary 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). Signature of Police Chief or designee Date O Sign re of City Clerk or designee 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. Office Use Only Approved application DCI report State certified driving record Website update _`ex ntl dgeaPPM10.a 09/2010 t�3, c ') �IQV S CA5 C Iowa Department of Transportation Office of Driver Services (Toll Free) 800332-1121 PO Box 9204; Des Manes, IA 503115-9204 515-249-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 7/18/2012 Name: Alawneh, Rafat Ahmad Address: 1453 DICKENSON LN City/State: IOWA CITY, IA 522409163 DL/ID #: 959AA9537(IA) Class: A Audit #: 6135854 Issue Date: 07/18/2012 Expiration 09/06/2015 Date: Endorsements: NONE Mailing Address: 1453 DICKENSON LN Restrictions: NONE Date of Birth: 9/6/1978 Mailing City/State: IOWA CITY, IA Sex: M 522409163 History Information Convictions Customer #: 212458 ID Status: VAL DL Status: VAL CDL Status: VAL CDL Cert None Status: 04/12/2007 CDL Med None Status: 04/22/2007 _. ... Restriction None Supplement: IA _ ... •. Citation Date Conviction Date ACD Explanation County JUR 10/17/2006 ___.. .. _._.-... 11/14/2006 ....._. ... ..- - -.. - X594 Speed __ ... ... Y _ ..- , -, 1WY _ 01/01/2007 04/12/2007 _ _ iS92 Speed _ 52 IA 04/22/2007 _. ... _ 04/23/2007 _ M14 Fall to Obey Traffic Sign/Signal .. i ._. 29 ... .. X52 IA _ ... •. 06/08/2007 _ 06/25/2007 JS92 ____,Speed _ ]A 02/29/2008 :05/15/2008- IM14 ':Fall to Obey Traffic Sign/Signal ':52 -IA 10/24/2008 ,01/02/2009 _ IM 14 :Fall to Obey,Traffic Sign/Signal _ 52 -IA 11/15/2008 02/04/2009 `M81 'Careless Driving •52 IA 12/10/2008 02/05/2009 S92 ;Speed .52 ,IA 02/08/2_010 05/13/2010 _ M14 _ Fail to Obey Traffic.Sign/_Signal _ _152 IA 04/08/2011 _ .04/20/2011 ;F02 No Child Restraint 152 11A Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number -- ]UR 11/09/2007 1404038 „IA _ 02/02/2008 ;423667 'IA Sanctions Type Effective End ACD Explanation Occurrence 3UR JUR Suspended 06/01/2009 106/29/2009 'W01 ;Habitual Violator SIA IA Name: Alawneh, Rafat Ahmad DL/ID: 959AA9537 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 —;.dorsements: Restrictions: State: IA I certify under penalty of perjury and pursuant to the laws of the State of Iowa that the documents and information presented is true and correct APPLICANT SIGNATURE Date: 10-28-2009 Comment: Date of Last Episode: — Comment: Medical Recall: Medical Response: N DOS Withdrawals: N Offense Question: N MOM Voluntary Replacement: $1.00 TOTAL FEES: $1.00 I certify under penalty of perjury and pursuant to the laws of the State of Iowa that the documents and information presented is true and correct APPLICANT SIGNATURE Date: 10-28-2009 Jul.30. 2012 9:59AM Jul. LJ. Lu l[ 5: 74rwi Div of Criminal Investigation No. 60,16 Y. 1 Lily LIerk - Wty of Iowa laity No. 2612 P. 2 STATE OF IOWA. Criminal History Record Clrcck —, -� Requlest Form ' ' To: low I1lvlsion of CrLninallavestigation Snppovt Operations Bureau, 11 Olocr 218 E. I,h street Acs Moines, Iowa 50319 (516) 129.6066 (515)725-6060 Fax DCI Account Number: Yv0A `I:-- (iteppircahle) From: CITY OF IOWA CITY CITIt upitim O $ICE 410 E. WASMNOTOX STREET IOWA CITY IOWA 52240 Phone! 319-356 bh5t: 319.356-5497 �1 I�owr�a Criminal History Record Check Results (ocra:a oeiY>, As of I ' �L�l s search of the provided name acid date of birth revealed: ❑ No Iowa Crinilnal History Record found with DCI V''' Iowa Criminal .history Record attached, DCT #�� DCI initials Received Time7'Jul, 23.((2012 3:34PM'No.0105 Jul.30. 2012 9:59AM Div of Criminal Investigation No.6028 P. 2 IOWA CRIMINAL HISTORY DCI 00829076 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- DCI:00629076 2012/07/30 NAME: ALAWNEH,RAFAT ARMAD DOB SEX RAC HOT WGT EYE HAIR SKU POS 19780906 M W 509 191 HAZ BLX FAR YY ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD +++ 01 ARRESTED 20080307 AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 01 IA STATUTE IA711.3-2 ROBBERY 2ND DEGREE - 1978 TRK#: IA003LI01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708,2(6) ASSAULT COURT CASE ID: 06521 FECR082572 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A003LIDI RESTITUTION SENTENCE DISP EFF DAT FINE $100 20081126 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCT. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION