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Home My WebLink About12-200�4r'lll� � � tllwlmi�1l CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 356-5040 �J`31 (319 - 497 FAX First FA15AL 1. Name Authorization Number / °L — a00 APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Middle 2. Mailing Address d I S /'� A Ve /V W fie, 3. Telephone: Home 52 1— $q 9-3 Other: (Office Use Only) Last Ab,/„6XaaI,-I" 4. Prior experience in transportation of passengers: Xi (iY lVeY - 3 yea Y S 0 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /\/O 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?� Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When rlrYtoY Ccs' id -y- f LC)waci-tt/ o9/z5/ID 8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? /A/ O 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) A) O 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) clei4 idrivbadq 06/2012 I hereby certi that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 3 5 I F _ G o 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 Date (n STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by %a Scr��dp�Ka „� On this -7�`Z day of ��4= /10'- SONO FORT (� zICoMm'Csosion Numner 75re791 Sa�rjn #sG- �i7�7� h r - °P409 .F- w�. Jt— 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). ��Z - Sig✓nyat re of Poli6e Chili r designee Signage of City Clerk or designee Date /�7— 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 SeNJ.ArWbeC pp2010 ac 06/2012 Iowa Department of Transportation C3C] Office of Driver Services (rdl Free) 800-532-1121 PO [fox 9204, Des Moines, IA 503D&9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: Name: Address: City/State: 8/24/2012 Abdelkarim, Faisal 915 A AVE NW CEDAR RAPIDS, IA 524054824 Mailing Address: 915 A AVE NW Mailing City/State: CEDAR RAPIDS, IA 524054824 Convictions Certified Abstract of Driving Record DL/ID #: 354AE9001(IA) Class: D Audit #: 5953511 Issue Date: 05/01/2012 Expiration 05/02/2013 Date: Endorsements: 3 Restrictions: NONE Date of Birth: 9/4/1975 Sex: M History Information Customer #: 5489270 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County JUR 09/25/2010 10/26/2010 S93 Speed 52 IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 09/25/2010 592868 IA Name: Abdelkarim, Faisal DL/ID: 354AE9001 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: ......... ,!.&/''4 IOWA N 7f aN�V%` 8/24/2012 Office of Driver Services Iowa Department of Transportation Name: Abdelkarim, Faisal DL/ID: 354AE9001 I Aug,29. 2012 3:01PM Div of Criminal Investigation No.1117 P. 9, "3e•+... cv is ,. ,,nI (-i L vi crn b t VI tuna t,l t)' No. z I ) I P. (/2 STATE OF IOWA - Criminal -Hi0orry Record Check Request Forms To: rowa Division of Ctlmbla17nvestlgiatlon Support Operations 13urea a, V.Ploor 215 F, 7ei Street Des Moines, Ioivq 50319 (515)925-6066 (515) 725-60H Vaa DCL Account Numbcr; ZWo' ~t--- (itapplicabW From: CITY OF IOWA CITE'" CITY CURWS OFFIC$ 410 h. WA.8I7 NG>TON STRYXr IOWA. CITY IOWA 52240 Fhonee 319-366-041 Fax: 319-356-6497 L,astNaml® (mandatory) I First NAME) (mandalory) Middle Name ommmcuded) L )ate of Birth (mandatory) Gender mandatory) Social Security Number (n qq/'04/4G 7 201- g2-2 �2 '�I1VIale ®I+omalo I WaiverAforniation: witho at a gigneawaiver from the subject of the request, A complete cr1mJaAJhJstDryyeco -a may not be releasable, per Code of Iowa, Chapter 692.2. For co lata criminal history record information, as allowed bylaw, always obtain a waiver slenatute from the sublect of the request, WWey Release: rherebyglvo Uemlissloa for linoabovo requeslingemolel(o wnduct on lotve.ulmrnalldstowlecord clleckwllhrho DlvlslonofQ;mina) lnvosligalion (DCI). Any criminal hisloty dale aonxmingme 16ot is meinlelnod by thoDCl may bo released mellowed bylaw. Walver gigndluve; SV r74 t/rIwu>aL Aals WA V ANi6l:VL lL &l Llxl 1:wi mri; (DCloscunly) As of U 1 V" l lI V a search of the provided natne and date of birth revealed: _ C� N 10 No Iowa Criminal History Record found with DCI* r C. civ 1' J Q Iowa Criminal History Recoxd attached, DCL # ca > _ - DClinitials r— m <eceived Time ,Au .24. 2012 4:23PM No.2071 1.j(;[-/ / IIINIAn11111 m SAAVENW -DAR RAPIDS, LA 52405 354AE9001 201 0 510 112 012 Exp Q&f3 isD f-� 3 V ::;NONE Y�" BAG 00(309/0411975 Do M53MIW13"Mazo 3rq--,5'2 ) -dq 93 USA '(A