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Home My WebLink About12-190CITY OF IOWA CITY 410 East Washington Street I a Cil Iowa 52240-1826 319) 356-5040 Q 19) 3S6-5497 FAX First ^ 1. Name /f 2. Mailing Address _ 3. Telephone: Home 4. Prior experience in transportation of passengers: Authorization Number /02 —/ 90 APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Last (Office Use Only) 1 Vito 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? AJO 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? .0 O Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? PS Type of offense Where When -I1 -2010 (XJ to QbN / f 'c -Siqui T_ G /0-23- 120/0 8 Has your drivers (cense or chauffeurs license been Suspen e o voked in the last five years / V 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) 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) dI.Me dd,b.d, 09�2= obl�o1L hereby certify that;have issued to me by the Iowa Department of Transportation a valid Chauffeur's license Slumber 2a CZd 02 . I understand that if I falsely answer any questions in this application, that Ills applicat on 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 #H#f####fM#iR#1#f##N#fef#*#k!*Mft*4**R1�M*R4fff44***f4fR4ff4*f411414lR4fk4f****R41ik444#RfR44kRf#f**t#**R4*!1f#k*R1RRfR4*!N*llfYlfflf*!!1111 STATE OF IOWA ) COUNTY OF JOHNSON ) Sbscribed and sworn to before me by t��o �i a\� =ar now a� Qk;ht� . �On this 30 day of �., Nota I(c in and for he State of low wa (l� 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). Signatur o Po i hie r designee Sigrikim of City Clerk or designee Date 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. ffi#44#1#f####4#f##fkf#H#*#fHR##Rff!#ff f 1flflflfNHfNHHlfiflf 1H111ff1fffl1H1111f 1ff f f liffllfff#Yf11ff11f##4if4####!f#f# #41N44H4#4#*!elf Office Use Only Approved application DCI report State certified driving record Website update deny ie ,cadge zo10a 0812949 � Jul. 12. 2012 10:35AM Div of Criminal Ynvestigationf hNo.L3225 lP. c1/2 VU 1. 7. 4V I L L . V L n1 V i l 7 v i c r n V I l V r , u n a b I l r F IOWA STATE ,History Record o t 10RequestForm To: Iowa Dlvislon of Criminal Investigation Support Operations Bureau, P Floor 215 R 7lh Street Des Moines,Iosva 50319 (515) 725-6066 ., (515) 725-6080 Fax I am r•eauestine an Iowa CriminalHistory Record Check on: DCT Account1'umber; Yoe (ifeppnoebtc) — From; CITY OF IOWA C1TY MY CLURK, 9 OFFICF 4101; WASHINOTON STRMT IOWA, CITY IOWA 52240 )Phone: 3X9.356-5041 Fax; 319-356-5497 Last Narae ((nandalory) Mrst Name (mmdalorsq Middle Name (recommended rNmil hbddliq �p,��s VdAaM Date of Birth (mandatory) Gender (mandatory) Social 5ecuri Number reammendcd) 11 1y/lq,-ti Morale [hemale 952- " o/(— y 1 �3 Wt ivep.Mfo.emation: Without a signed waiver from the subject of the request, a complete criminal history record may not 'be releasable, per Code of Iowa) Chapter 692,2, Y,or complete erlminal history record information, as allowed by law, always obtnin a walver signature from the sub Itet. of the request. WIWYOIZelease: T hereby glVe pennlssion Por the above requesling official to conduct an town uhninol historyrccard chuk wish IIIc Division of Criminal lnveellgegon (DCI), Any almind history da(a ancemingme Ihu is maimained by the DCI may be released as allowed bylaw. Waiver signrtturei_ 4Ila S Yowa Criminal History Record Check Results (DClvso Only) As of 1 " U a search of the prov'jded name and data of birth revealed: No Iowa Criminal History Recotd found with DCI Iowa Criminal HistoxyRecoxd attached, DCI# DClinitials T m'1' u9.e�Received l. •2012 2:02PM No. 9177 ACIowa Department of Transportation Office of Driver Services (roll Free) 8011-532-1121 PO Bax 9204, Des Manes, IA 50305-9204 515-244-9124 OFAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 6/28/2012 DL/ID #: 320AE2102 (IA) Customer #: 5468556 Name: Elkinin, Abdalla Idrls Class: D ID Status: None Iowa Department of Transportation Mohamed Address: 2422 BARTELT RD APT Audit #: 5874330 DL Status: VAL 2C Issue Date: 03/22/2012 CDL Status: None City/State: IOWA CITY, IA Expiration 11/15/2014 CDL Cert None 522462708 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2422 BARTELT RD APT Restrictions: NONE Restriction None 2C Date of Birth: 11/15/1971 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522462708 History Information Convictions Citation Date Conviction Date ACD Explanation County ]UR 05/15/2010 06/16/2010 �1150 .Improper Turn X52 �IA 10/23/2010 01/06/2011 M14 Fail to Obey Traffic Sign/Signal 52 IA 11/04/2011 .12/06/2011 M14 Fail to Obey Traffic Sign/Signal 52 IA Name: Elkinin, Abdalla Idris Mohamed DL/ID: 320AE2102 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that 1 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: •f;Y 6/28/2012 IOWA0. T...: . •"•"• S�` fifil Office of Driver Services k EA, Iowa Department of Transportation Name: Elkinin, Abdalla Idris Mohamed DL/ID: 320AE2102