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Home My WebLink About13-284 Authorization Number 3 -" 2-EL-I • r1 (Office Use Only) • --+— mogiglir 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) 356-5040 (319) 356-5497 FAX First / Middle Last 1. Name [Y)LI.�Sf-n#l- [=CGL r- (D/72.Q-tom �L 2. Mailing Address 9 Lie 2 rrfe.,C& /Q- 2 i) SZ 2(1--6 /04-Va. (j / 3. Telephone: Home SI S!2 l Lj55 Other: -z.-f4.3 4-0 2.6 4. Prior experience in transportation of passengers: /;1 70.--ycd-�.� / 1�(.Ac-J �✓�� 6k)( c/r /�dr - a, 0 , yams-; 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? NC) 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? isle', Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /\J 6 Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? r) 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) 1' 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerk/taxidrivbadg 03/2013 Bkit I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number , . 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) L ; Signature of Applicant ��5/G` ��" Date /-2- — — STATE OF IOWA ) COUNTY OF JOHNSON ) _j Subscribed and sworn to before me by I� s4ac �f?pec/i . On this -2,G day of SC ///. ,"i (Y _-3, j„ 1 i Notary ublic in and for the State of Iowa `?`2 3 ./_, 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). _�l�Shr. -, 1 —a4-/7 Signa . e of Polic:'C P-f or designee Date / YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. 7 1 1 Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/2" (width) and 5'/z" (height) and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update derkrtaxidrivbadgeapp2010.doc - 03/2013 aDec. 18. 2013310: 25A% Div of Criminal Investigation No. 8581 P. 9/11 �. � iv, turd I ,71ii vlty vicrn vity vi Luna vitt au. YLVU I. 1/ 1 • • ,•1di Is CriminalBistor� 8ecorK eck w:nlolvOr ' ia Is� Request Forafr ri� s DCIAccoun Number: 4003 -P (ifapplicablo) To; Iowa Division ofCriminal Investigation b'rom; CITY OF IOWA CITY Support Operations fureau,l''Flo or. CITY CLERr S OFFICE 215$r 714 street 410 E WASHINGTON STREET Iles Moines,Iowa 50319 (515)725.6066 .mel _ e (515)725-6080 Fax phone; 3193565041 Fax: 319-356-5497 . Tam requesting an Iowa Criminal History Reoord Check on: ' Last Name (mandatory) First Name(msndolory) Middle Name(recommended) pate of Birth(mandator%) Gendd�er(r/(mandatory) Social Security Number(recommeended) 0 14 i 7/7 70 LNMale ❑B'emaie IA 30 0 / g9 Waiverinforma/l0n:Without a signed waiver from the subject of the request,a complete criminal it istory record may not he releasable,per Coda of Iowa,Chapter 02.2.For complete criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request K'aiverReleace:therebygivepormlaslonfortheaboverequestingofficisitoconductanIowacriminalhistoryrcoordoheck• lihtheDivisionofCriminal 7nvc,Ogalion(DCI). Any criminal history dote concerning me!het la meiraelocd by the DCt maybc released as allowed bylaw. Waiver Sigliafu••. Al - ,r — % - ^2 , J d Q.A__ Iowa Criminal History ReQord Check Results (DOmao only) As of 0— I ()w 113 ,a search oftheprovided name and data of birth revealed: • • 02 No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached,DCI# DCI initials 146 ' Received Time Dec. 16. 2013 1 :45PM No. 4706 Page 1 of 1 1111111 Iowa Department of Transportation r Office Df Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Moines,IA 50396-9204 iglIP 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 12/14/2013 DL/ID#: 748A34707(IA) Customer IF; 6158288 Name: Omer, Mustafa Elhadl Class: D ID Status: None Address: 2402 BARTELT RD APT Audit#: 7609827 DL Status: VAL 2D Issue Date: 12/13/2013 CDL Status: None City/State: IOWA CITY,IA Expiration 08/29/2015 CDL Cert None 522462703 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2402 BARTELT RD APT Restrictions: NONE Restriction None 2D Date of Birth: 1/1/1970 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522462703 History Information CLEAR DRIVING RECORD Name: Omer, Mustafa Elhadl DL/ID: 748A]4707 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: WIWI B'Np �** 404,� 12/14/2013 See IOWA .•1s 'sy�:.D. O. T. ,,,''�� ces �� ` owaeDepartmenof Driver t ofTransportation Name: Omer, Mustafa Elhadl DL/ID: 748A34707 12/14/2013