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Home My WebLink About12-157Authorization Number r 1 (Office Use Only) �r"III 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 City, Iowa 52240-1826 (319) 3S6-SO40 (319) 356-S497 FAX First Middle Last 1. Name June\ rie F�,.� Gh�r h 2. Mailing Address \5 3. Telephone: Home 3\9 A -6b - 3b O� Other: 4. Prior experience in transportation of passengers: 'mss �r s 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When \ C' 1_\IZ3 /Z003 Oc-t`crcc 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the I t ive years? N O Type of Offense Where When T Have you been convicted of any traffic offenses in the last five years? ye` Type of offense Where When S ?C c8.-Cn Sp<cd. �ti�+so. Co _Z Z 7 Zoog 8. Has your drivel's license or chauffeur's license been suspended or revoked in the last five years? ao 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) cleM.Idri, adg 09/2010 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 8 c a Y < < s b b . 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, lowa,'jn 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 j Date 4H+HfffY##H#H*****44*R4ffHH4H#HH#H#*#***RR**RRRf*RfY4RHHffHY+###lfHf##f##H###+*##*4R**RH+RR4Y4HRHYHf####*H*iii*RHifY4Hf#!f STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by —10�'hn On this day of Nbtaqc6 blit in and fort the Statebf Iowa •v i t4 *#*kkikkf*tf 4k#4f t}tltf*tt*i*#ttkiiif4ki*#4#f f ff H}tHtt}f ttH#*#*k*##4k##f 4f 4 k1Hf kHf kkf kf HHf fHf }4f f H*Mffif f f t*k###*#**Hf *f kk#Hf f HYf4kf 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). Date Y -e -la 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. Hfff##iffffffffYi4lf*kH##}f#**f#fffffH4H**f#*f##1f##%*##*f*#f#fH#HfMffffffffffHfH#fFY#H##H**#***f4f1f*f#f#ff f f ff f 1fffHHH##*#1'i*fH Office Use Only Approved application t/ DCI report State certified driving record v Website update Z de"wjdnvbadWapp2010 d 09/2010 Aug. 1. 2012 5:02PM 07/J1/•Lu12 1e:U0 YAA t ' A z Div of Criminal Investigation n 4 DCI IOV6681 IA STAU OF IOWA Criminal History Record Check ' Request Form Tot Iowa Dividon of Criminal lovestlyatloo Support Oper eflum Burma, In Floor 116 & 7* Stmd Dordolum,lowa 60319 (915) 7:S6a66 (Sl') 7:5,6010 F{a I .... n.n,wrtnn 5,n Iowa (''I,nln.l %Ilefni„ a�rnnl C`h,vdr nn�• �YyJV Last Name (ff*wmrn Myst Name DO Account Number: 30-�-Jt"Ok4M;)- From, Vndr(esTa><I G'114ri b (r 5k'-Vwi Qv� Date of Birth oa, A Sa3'1 v phone: .i 312 5,38- irry' Faa:.. 3l9 56-1-15-11 WaW r,t (ronlW Zvnt WMent a dgoed waiver from the subject of the requed, a compltde criminal Mitory record may not Last Name (ff*wmrn Myst Name Middle Nome (law G'114ri b C�uel;r,e Ann Date of Birth Geader 9oeisl 3ecori Number ❑mot Eemde WaW r,t (ronlW Zvnt WMent a dgoed waiver from the subject of the requed, a compltde criminal Mitory record may not be retupble, per Code of low{, Chapter 671,1, For complete criminal history retold larotmatioo, u allowed by taw, always obtain a WAYarsinatore from the wYblKt of 1b rMWL Waiver Rdeme: I hmsbyeivr perakion for Iteeeoummo dont w tuwnhd in toMewk&W hirlow.—, Chock waheoolvfrbe utcftbul Imedplfon(jp(C0• Any mmtort hbbry drr oacaom{ion aahanteheeYW qme DCl:neyb rolaredu elfoNed try N,e /\ WOI►YI SIgtOJt/e: Iowa Criminal Matory Record Check Results (OCIM"'A As of—lid i ilk a search of the provided name and We of blah revealed: ❑ No Iowa Criminal History Record found with DCI Iowa Criminal history Record attached, DCI HUnt I ' DC1Initials V -- DCI -77 (OGW110) Rp.r.aivatl Tima Aid. 11. 9019 9:69PM Nn. M91 t Aug. 1. 2012 5:02PM Div of Criminal Investigation �•' IOWA CRIMINAL HISTORY NON CONVICTION DCI:00668102 NAME: GHARX)3,JACQVHI,INE ANN WRIGHT,JACQUELINE ANN 11013 SEX RAC HGT WGT EYE 19$90922 F W 501 172 HAZ ADDITIONAL IDENTIFIERS CCH RECORD "*• DCI 00600102 PAGE 1 OF 1 DATE PRINTED - 2012/08/01 HAIR SKN POB ELK MN No -6667 P. 2/3 01 ARRESTED 20021226 AGENCY: IAO520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#; 100751701 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(A) OPER VER WH INT (OWI) / IST OFFENSE COURT CASE ID: 06521 OWCRD64276 CHARGE CLASS: NON CONVICTION TRK#; 100751701 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT APPEAL DATE DEFERRED JUDGEMENT 20030423 20031023 PROBATION 365D 20030423 COMMUNITY SERVICE 50H 20030423 DISCHARGED FROM 20040310 DEFERRED JUDGEMENT 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 DCI. 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 22 Iowa Department of Transportation Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/7/2012 Name: Gharib, Jacqueline Ann Address: 215 BROWN ST City/State: IOWA CITY, IA 522455801 Mailing Address: 215 BROWN ST Mailing City/State: IOWA CITY, IA 522455801 Convictions DL/ID ft: 803YY1566 (IA) Class: D Audit #: 5888699 Issue Date: 03/29/2012 Expiration Date: 09/22/2012 Endorsements: 3 Restrictions: NONE Date of Birth: 9/22/1959 Sex: F History Information Customer >Y: 5056591 ID Status: EXP DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: t1Qj14/2008 Citation Date Conviction Date ACD Explanation County JUR 12/25/2002 104/23/2003 A20 Deferred Judgment OWI 52 IA 08/28/2008 t1Qj14/2008 S92 Speed 52 IA 12/21/2008 02/02/2009 S92 ..Speed 52 IA Operating While Intoxicated Test Refusal/Test Failure Violations occurrence ACD Explanation JUR 12/25/2002 A90 OWI Test Failure IA Accidents - Accident involvement Indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 06/21/2008 448133 --TIA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked '.01/05/2003 107/04/2003 A90 OWI Test Failure SIA IA Name: Gharib, Jacqueline Ann DL/ID: 803YY1566 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: 8/7/2012 azeme:nl k2 Office of Driver Services Iowa Department of Transportation Name: Gharib, Jacqueline Ann DL/ID: 803YY1566