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HomeMy WebLinkAbout12-213Iowa City. Iowa 52240-1826 (319) 3S6-5040 (319) 3S6-5497 FAX ddle 1. Name /'0K21jed L51c�,iA4W I -('S6" e- 2. Mailing Address 2Sgy Q&r�e#- 19D 19 P r t C 3. Telephone: Home ?/ 9' -G q9 -21 G o Other: 4. Prior experience in transportation of passengers: l alork /';ks e , a oaj / wa 9 N-coy'11Fd CLA l'VowAC jr-hj-t." iv, w1Y GOul4fV't0 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /VC 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? ; y0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 00 Type of offense Where When 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? 00 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) V\_10 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) tlerWtaxidnvbadg 06/2012 Authorization Number / ,�?_ — �;,L/ 3 (Office Use Only) Mlw®a�Il 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) 3S6-5040 (319) 3S6-5497 FAX ddle 1. Name /'0K21jed L51c�,iA4W I -('S6" e- 2. Mailing Address 2Sgy Q&r�e#- 19D 19 P r t C 3. Telephone: Home ?/ 9' -G q9 -21 G o Other: 4. Prior experience in transportation of passengers: l alork /';ks e , a oaj / wa 9 N-coy'11Fd CLA l'VowAC jr-hj-t." iv, w1Y GOul4fV't0 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /VC 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? ; y0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 00 Type of offense Where When 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? 00 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) V\_10 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) tlerWtaxidnvbadg 06/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 1S/a flOhQ 2 1 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 (a� �P� (o A Date (/A/ /z RlIYYYY##1114#Y+HYi4N'Y4Y44+i4R4RRR+RR*RRlR4lRRRRlRl4fYlfYlMflfff11f1fflf�lf!##!f###4Y##4##1F##4#H#4#++R4##Ri#R4###RR4RR111fiflfYY*ffY#1f##'k### STATE OF IOWA ) COUNTY OF JOHNSON ) S bsCribed and swgt_n to before me by I � ,ko_ 'e" �' V'J. On this I day of � c .est /_ © 12 K. I U I ILt giRi otary Public in and for the State of Iowa 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 of Police Chief or designee 1 fit Sign Clerk or designee S /y iz 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. ******ff#iffffiff4f#4flflfif4Y####4##if#!4i!*#***#*##****f*t1f*1f11ff11111111111f1f1H1f11f111f11f111ff1f4#144#l141###4##i##4####**f*ff#lfflffff Office Use Only Approved application DCI report State certified driving record Website update �baa,�M0 a 06/2012 Aug.29. 2012 3:OOPM Div of Criminal Invest wgatio i STATE, S1O.WA Criminal 1 :•'1"v Record Check 4)RequestForm To: Iowa Ilvision of CriminalInvestiyatlon Support Operations Dureau,1" Floor 2181x. 716 Street AaaMoines,lowa 50319 (515)M-60(6 (515) 912-6000 Vex hNo,�1777 PP. 2 ACIAccount Number: (ifapplica6lo) From: CITY OF TOVrA CIT17 CIT$ CLUXS S OFFICE 4109. WASHI1NGTONSTREVT IOWA. CITY IOWA 52240 Phono; _ 319-966-5041 Fox; 3193563497 I ainrequoatingenlowa Crhninal History Record Check on: Lastxfflue mandato N11'&tNarne mandatory) MiddIONaMe(rewmmended) N6 JL4 Date of Birth (mandatary) rveM lOr (mandatory) Soaial rSeeutitVNumber acwmmu,dcd) l AUa2wl6C&Il °11 ?9 5 I dMa(o I]Fomalo 1/ % — 17� 1 O/ 2 I WitivepInfoyffielfion. Vithouf a signed waiver Vern the subject of the reque9t, a comploto criminalhistoyy record may not I bo releasable, per CodoofIowa, Chapter 692:2.For oto criminal historyrecordinformg1(on,a8aliorvedbyrart,always obtain a waiver signature from the subject of the reauest. W lve?ReleQSe.llimbyglvopemilsslonforthoaboverceImIlnsoaloldtoconductanIowaariinlne!biilarymcordoheekwhhrheDIVlslono(Criminal Investigatlon(DCI. Any arimh,alhlatory data coneeminomethat is malAmined by the t)Ctnray be released a a allowed by Lev. Waiver AUWa a_.1.'1IUIILUA JulstU.0 11'ruor(L ,=•(DC(V,`) inn .l`I o� �� As of a Search of the provided uaM8 and date oibirthrevealed; �:7 = ca No Iowa CiiminalhistoryRecordfound withDCC _ ter; Iowa Criminal IlistoryRocoxd attached, ACI# DCI initiais� Received TimePui�27;112012 12:50PM No. 2139 Aug29. 2012 3.;OOPM��uDi�\v of, CrI\ imina1l Inv V 1 es1tigaVLL tVionI ...• p/-.� LV IL 1 L ) VYIVl) .1Il) Criminal Higiory Record Check Y` 1 \ Jl y'pt�J l! p; e I t t To; town Alvisior( of Criminal Investigation Support Operations Bureau,11"Moor .219D. 71h Street DwMoines,Iowa 50319 (515) 725-6066 (516)126-6000 )lox Iolva CrhninaI History Record Check on: hNoU..�1777 11.17 PP. �2 ACIA000untNu,nber: �i`� oa _ F (irapplicahio) From: CXTY OF XOWA CITY CITY CLBRX S OFFICE 410 2. WASb1I1 GTON'STRFL+T IOWA. CITY IOWA 52240 Yhonol - 319-556-5041 Fax: 319565497 Date ofBirth Gnendamrvl Ceuder r darpwi Soetal Reeurity Nnmhrr r., mm.pnn\ Idow''t/Ikyl1oi17ff) I Malo ®Female I /% —17� G o0/ 2 WaipevlI2foyfl4don:Vithouiasigned waiver fkomthe, subjeetofthe request, acomplotoertminalhistory record may not I be releasable, per Codo of Iowa, Chap ter 692.2. For gQm plot e criminal history record i nfarmrl l lon, 28 allowed by la W, alvinys WaWr ReleaSe: I herebyglvo pemilsslottforthe above requesungoalolrllo conduot onlowaoriminal b(rtoryfecord oheekwlth the Dlvlsfon o(CrIminel Invesllgautin(DeI. Any gigllnsl GlsPory delaconeemino melhatie malnroleed by tho DCimaybere(easedasaflowedbylaw, WiriverVPHafHvv. 1d X61 y� /Lt�i As Vrr No Iowa Criminal History Record found with DCI X Iowa Criminal IlistoryRecord attached, DCI# DCI iaitials ,leceived T]ime:Aulgl.27;1(121012 12:50PM No. 2139 hrevealed: r(DCIue pn(y) l_ � rJ7'' Ci)�7 Iowa Department of Transportation i I c, Office of Driver Services (Toll Free) 800-532-1121 PO Boa 9204, Des Moines, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/29/2012 DL/ID #: 575AH0683 (IA) Name: Mohamed, Mohamed Class: D Babiker Elwasila Address: 642 12TH AVE APT 5 Audit #: 5856940 Issue Date: 03/14/2012 City/State: CORALVILLE, IA 522411773 Expiration Date: 11/19/2017 Endorsements: 3 Mailing Address: 642 12TH AVE APT 5 Restrictions: NONE Date of Birth: 11/19/1983 Mailing City/State: CORALVILLE, IA 522411773 Sex: M History Information CLEAR DRIVING RECORD Name: Mohamed, Mohamed Babiker Elwasila DL/ID: 575AH0683 Customer #: 5915479 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: - ""••:w/J,���� 8/29/2012 IOWA 'z' D. 0. T.: rv; =e6v-07 aec--Vc�sl- Pf ORIVEN S Office of Driver Services -R-'= Iowa Department of Transportation Name: Mohamed, Mohamed Babiker Elwasila DL/ID: 575AH0683