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Home My WebLink About13-252 r Authorization Number ) — (Office Use Only) III APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (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 2/101,0r( / H S /I vg, 2. Mailing Address (�� C 'R t � � �� f]��-- i1 �t 2t i ---a "IL `1 3. Telephone: Home Other: ot • J V\}-( 4. Prior experience in transportation of passengers: 1 61A 1 r ` G ,((450 C_.( L4 wIL 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? j\J� 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? jJO Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /VC Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /V 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) 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) cIerMax;drivbad9 03/2013 I hereby c- ti . thak I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license'numher -- � 2"% ) --3 ZA.)6j-)-V 8 . I understand that if I falsely answer any questions in this application, that this ape.`.t• 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 Applicant9 D Date t U -'-‘7 - 1� ************************************************************************************************************************************************ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to Joefore me by /\L()tce-CQ /-t . 2 A.4t- , ) . On this c:3 Jrd.t.. day of ter'" WENOY S.MAYER No ary Public Ti . for e State of lo g 4 i Gem,,,�a.:on Numb.,749420 My Com ssion Expires oW -•1-1'1J-1 IS ************************************************************************************************************************************************ 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). Sign re of Po Chief 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. /2c7 Signa re of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 5 1/2 (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerkRaxidrivbadgeapp2010.doc 03/2013 Oct. 22. 2013 2: 28PM Div of Criminal Invest igat ion No. 9929 P. 1/3 V41. IU. LVID iu. iinui Vltr Meta catty' UI 1UYfa loll; I1'U. WVIJ P. • STATE OF IOWA �', ttl� I 1,- it.li Criminal History Record Check - ;owe l ( � ' I' k. „ iir, Request Form I°4 DCI Account Number: Gap el. (ifepplirable To: Iowa Division of Criminal Investigation From: CITY OF IOWA CITY Support Operations Bureau,II Moor CITY CLERIC'S OFFICE 215 E.ph Street 410 E WASHINGTON STREET Des Moines,Iowa 50319 (515)725-6066 IOWA CITY IOWA 522/IO (515)725-6oso Fax Phone: 319.3565041 Fax; 319356-5497 I=requesting an Iowa Criminal History_Record Check on: Last Name (mandatory) First Name(mandatory) Middle Name(reeommended) �5ww►( Ahmed 11404 In Date of Birth (mandatory) Gender(mandatory) Social Security Number(recommended) 621014 tq 10 4216ala t7Female s60-7q- o Waiver Information:Without a signed waiver from the subject of the requevtl a complete criminal history record may not be releasable,per Code of Iowa, Chapter 692.2.For complete criminal history record information,as allowed by law,always obtain A waiver signature from the subject of the request. _ Waiver Release:T hereby give permission for the above sequesling ofeial to conduct an Iowa criminal history record check with the Division of Criminal Investigation(DCI). My criminal history data concern" g t Ihel" maintained by the DCr may be released as allowed by law. Waiver Signature: / // i /,Iowa Criminal History Record Check Results (Dclui1oonli� As of /V -aa-/3 , a search of the provided name and date of birth revealed: • J�J No Iowa Criminal History Record found with DCI • 0 Iowa Criminal History Record attached,DCI it DCI initials . Received Tirle'0ct. 18. 02013 10: 55AM No. 9644 1 Iowa Department of Transportation C83 lir fti Office of Dever Services (Toll Free)800-532-1121 PO Box 9204, Des Manes; IA 50306 9204 515-244-9124 411111110 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 10/16/2013 DL/ID #: 732A]6748 (IA) Customer#: 6138609 Name: Ismail, Ahmed Hassan Class: C ID Status: None Address: 1960 BROADWAY ST Audit #: 7326748 DL Status: VAL APT 7A Issue Date: 09/10/2013 CDL Status: None City/State: IOWA CITY, IA Expiration 11/02/2014 CDL Cert None 522407022 Date: Status: Endorsements: NONE CDL Med None Status: Mailing Address: 1960 BROADWAY S-1 Restrictions: NONE Restriction None APT 7A Date of Birth: 8/2/1970 Supplement: Mailing City/State: IOWA CITY, IA Sex: NI 522407022 History Information CLEAR DRIVING RECORD Name: Ismail, Ahmed Hassan DL/ID: 732A36748 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: -'EHICIf p`'a, .,-A •....... 10/16/2013 . : IOWA %.01,, •,ti: : *5 clirs40107.• c-7,•..D. 0. T. tit% eiet.ieredi ., 11,,'4, *........0--- Office of Driver Services <`��.�„IVER,- Iowa Department of Transportation Name: Ismail, Ahmed Hassan DL/ID: 732A36748