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Home My WebLink About12-192�r"III CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name 2. Mailing 3. Teleph Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday – Friday.) A2-i94Q- (Office Use Only) 4. Prior experience in transportation of passengers: —tzzV .I 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 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?_ i\� Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Ll () Type of offense Where When 8. Has your drivers license or chauffeur's 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) /�, i (; 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) cW .idnwadg 06/2012 I herby certify that I have issue to me by the Iowa Department of Transportation a valid Chauffeur's license number VV A, y i'4�A w. o. �� 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 Applicant Date STATE OF IOWA ) COUNTY OF JOHNSON ) bscribed and sworr5 to be ore me by N (War J'�C _(V k -C--C —�—) On this "� ' day of a°" KELLIE K. TUTTLE Notary Public in and for the State of Iowa z CaIIItIII551L11T!lu...QEI'Z27gT9 My Com�nissigfi Expires 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). S nature Police Chief or designees Signature of City Clerk or designee' qs/Z 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. 111N4####+#4*««11«11114#4#4«#4««##«11411##4##'H4««*H1«*«11«111.411141444##4#«#4««*««1*««fef*11f144444#4«#4*'#*4*«««111111#44######4#«««1.«1114#1 Office Use Only Approved application DCI report State certified driving record Website update Gedvlezidr badgeapp2010d 06/2012 Iowa Department of Transportation Office of Driver Services (Tall Free) 8M-532-1121PO Bax 9204, Des Maines IA 5030&9204 51'x244-9124 FAX: 515-239-1837 History Information CLEAR DRIVING RECORD Name: Hamad, Amar Hamad Mohamed DL/ID: 424AF7780 the 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 custodian Office of Driver Services, that s Is a true and accurate copy of an officia said office,and that I h have been uthori ed by the Director of the InwatDepartment of Transportation to so certify. I record currently In the custody of 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: '.•"'"' .�� IOWA 3/8/2012 Certified Abstract of Driving Record eev 06COOWM1 rF•0 ""•• Inquiry Date: Name: 3/8/2012 Hamad, Amar Hamad Mohamed DL/ID #: 424AF7780 (IA) Class: C Customer #: ID Status: 5612537 None Address: City/State: Mailing Address: Mailing City/State: 2420 BARTELT RD APT 2D IOWA CITY, IA 522462707 2420 BARTELT RD APT 2D IOWA CITY, IA 522462707 Audit #: 4247780 Issue Date: 04/07/2010 Expiration Date: 11/22/2015 Endorsements: NONE Restrictions: NONE Date of girth: 11/22/1965 Sex: M DL Status: CDL Status: CDL Cert Status: CDL Med Status: Restriction Supplement: VAL None None None None History Information CLEAR DRIVING RECORD Name: Hamad, Amar Hamad Mohamed DL/ID: 424AF7780 the 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 custodian Office of Driver Services, that s Is a true and accurate copy of an officia said office,and that I h have been uthori ed by the Director of the InwatDepartment of Transportation to so certify. I record currently In the custody of 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: '.•"'"' .�� IOWA 3/8/2012 D. 0. T. 09 eev 06COOWM1 rF•0 ""•• Office of Driver Services Iowa Department of Transportation Name: Hamad, Amar Hamad Mohamed DL/ID: 424AF7780 Aug.16. 2012 3:07PM I ,Div of Criminal Investigation STATE OF IOWA V.' (rrfi inalmistory Record Check.. • •�L II, Roques>t Form To, IOWA DlvlslotaorcrimtnalYnyeSflgyl[ph Support Oporaflons Nuronu, V Moor 215 E. P Sfreot bas lv(o(ne5, Tolya �os19 (sls)i25.6o66 (516)125-6090 $arc Record Check 0?.L9343 PP. X1/3 )DCI AccotlatNtlmbor: c 0 npplloAbfo)^ Froln, CITY 017 IOM GI_CY CITY Cu"15 onlcv _ 410 'G. WARniY GTO9 SMUT TDVA CITY U240 Phone., 319—a56--!iQAj� - Fax: 3Y9-356-5&97 �� H41m ad AVI/1QI ►na� 4walww ,Da'EeofO9irttLrnp4dem 0011deY(mmdalo) soci,1,jseelyrity�jl�'1/j1112 6U bUWa&6l 4(oYrMdl7DYlvMhodtasknerYWAlvel•iyomlhesubjeatofthoro rlmt-)n zoroplatoorkinalhfsfory'erlallnalhistoryreeordIllurMatlorf,93alla%y6a obtafldwalVb)-fann0lvarlA",lAn.mddwnFnPlkn,ma:ee.' icYlctbe>'t(eCelrSel rnvasn®al{oa Olco, An; (orihoryboyaropulln@ offfu/Al fo canduol enrewa orlminOlfilalolyrecord checklVd6lhaDfvfslon ofCriminol reemlT-1" hhtlamMlnodbyMob 0fineyberoleasedwaffofycdbyla%v. a+w.au ova v i«.a.v;µ �a4�4.R AAG4I UALJ� , • (ocl oro only) 1f s o£ (O a north of thcprovVdd name and date of birthaevealed; r i No rowa Gillnfrial iT,tstoxy Record (bund 'with b Cl _c*j d rovPa Climina[iils(pry�tscotd attached, bCx# o:� W r- o nci tr Received Time Aug. 10. 2012 2:IOPM-No, 1175