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Home My WebLink About12-198� r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 –35 _ sysy Fr1 (319) 356-5497 FAX 1. Name 2. Mailing 3. Teleph Authorization Number /J- /g4( (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday – Friday.) 4. Prior experience in transportation of passengers 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? K(� 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?— �Z) Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Tvoe of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? . 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) derMt rdnvbadg 06/2012 I hereb� certify that I, have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number - 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) Signature of Applicant �Gf/ Date 2 Q 41-9.,)/Z STATE OF IOWA ) COUNTY OF JOHNSON ) I I 1 40�cribed nd sworn to before me by t GL A i A �� 0-0- I � On this f `— day of )�Pc CI,o44�o 1 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 bf Police Cfyref or designee Sign re of City Clerk or designee S� d, ,2e Date =7 /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. #f111f#1f##N###k#*#RR#R##t*##Yfffffiff!#ik#M*44*#4*#*#*R#fRR#RR#Rfiff#MlffffHfflffff!#4f#f#1f#Nf#f#4##R44*RR#4fy:RRR#1Rf#f#f1111N##f##Yk4#}R Office Use Only Approved application DCI report State certified driving record Website update da,wia jm badg.a 2010. d. 06/2012 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 Inquiry Date: 8/15/2012 Name: Dafaalla, Hamid Elhag Address: 2654 ROBERTS RD APT 1C City/State: IOWA CM, IA 522462741 Mailing Address: 2654 ROBERTS RD APT IC Mailing City/State: IOWA CITY, IA 522462741 Name: Dafaalla,•Hamld Elhag DL/ID: 123AC0351 Certified Abstract of Driving Record DL/ID #: 123AC0351 (IA) Class: D Audit #: 4652559 Issue Date: 09/07/2010 Expiration Date: 01/01/2013 Endorsements: 3 Restrictions: Corrective Lenses Date of Birth: 1/1/1958 Sex: M History Information CLEAR DRIVING RECORD Customer #: 3360412 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None 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. 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: •- •:;GJ;'p� 8/15/2012 IOWA r NO S�@ Office of Driver Services Iowa Department of Transportation Name: Dafaalla, Hamid Elhag DL/ID: 123AC0351 %tug.24. 2012, 4:28PM nue. LV. LVIL L. RLI V1 Div of Criminal Investigation blip UICIA — l.11y 01 10Wd Ulty No.2074 P. 4/6 No, 1143 P. L STATE 00 IOWA X41 ( I I; .I,II History Record ChEkkS. •"?�{?a'�< - DC7 Ancount mb- To: XoWnDlvtalonof6-lmivalXnvestlgatlon SupportOparatlonaPuremi,1"Floor 215 B. 7'I' Street Deslbloines,Xolva 50319 (513) 725.6066 (515) 725.6080 rax Promi CXTYOFIOWACITY CITY C)EIFIPKIS 01MCE 410 L. WASHMOTON-STR29T XOWA,CITY IOWA 59,240 Yhonol 319556-5041 Paxl 319-3565497 Iowa Criminal History Record Cheok Reoulft Agof—g&Nlza,asearchofthe providedmmneand date ofbirth reVealed., 01 F IJ No Iowa Ca'lminal l istofy.Recozdfound vllthDCI Iowa Criminal history Record attached, DCI# DCZ Received Tme Aug. 20. 2012 Time 2:49PM No. me