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Home My WebLink About13-247 . Authorization Number / r . 7 1, l (Office Use Only) .ter- int / ,4 ggi°°'�i 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.) ova City.J.aw?.._52240-1826 (319) 356-5040 71 (319) 356-5497 FAX Fir t •Middle \Last • 1. Name M.ro lekY"r � 2. Mailing Address 30\ r 5a , Ly_ 3. Telephone: Home - f —i / — 3/; (� Other: 4. Prior experience in transportation of passengers: 3 (Lev t, S I L. -5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /v' Q Type of offense Where When 6. Have you Leen convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? \.. ,3 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? fib 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) I DEPARTMENT OF CRIMINAL INVESTIGATIO ` P CI)`R PORT 'ND STATE CERTIFIED C �r DRIVING RECORD MUST ACCOMPANY THIS APPLI ,TI• ' •R POLICE CHIEF REVIEW You must apply for a vidual Department of Criminal Investigation Report(form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) 03/2013 t$ . 1 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license rf mis)T-Dr ` '. 1 r'1 3 1 C 1 5 . 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 t 0 provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) � Signature of Applicant �� Date l C/1 7_I Z 0 \ 3 411/ II STATE OF IOWA ) COUNTY OF JOHNSON ) bs ri ed and sworn to before me by I ► k.J�� 47-\ KhC Ill . On this I -1 day of I 7iDG ,Y4, CHARISASORENSEN 04;1, . i : , Commission Number 772028 •Notary Public in - d • the State of low2 ''— • M 7lrir fires I f-' *************..**.******************************************************************************************.*********************************** 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). 7.5vi...2...,./ 'o Signature of Polic hief 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. --22Lic Signaturity Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 51/2" (height) and prominently displayed to all passengers. **..**.**...**........*.*......***.....................,k,.******.***************..,,, .**..*..., .****...*..*.....................,......... Office Use Only Approved application DCI report State certified driving record Website update clertdtaxidrivbadgeapp2010.doc 03/2013 r'' Iowa Department of Transportation OC83 Office of Driver Services (Toil Free)800-532-1121 PO Box 9204,Des Moines,IA 50305-9204 515-244-9124 FAX:515-239-1831 Certified Abstract of Driving Record Inquiry Date: 10/9/2013 DL/ID#: 739A39915 (IA) Customer#: 6149393 Name: Khalil, Mohamed A Class: D ID Status: None Address: 301 7TH ST Audit#: 7421685 DL Status: VAL Issue Date: 10/09/2013 CDL Status: None City/State: CORALVILLE, IA 522412015 Expiration Date: 06/25/2018 CDL Cert Status: None Endorsements: 2 CDL Med Status: None Mailing Address: 301 7TH ST Restrictions: NONE Restriction None Date of Birth: 6/25/1966 Supplement: Mailing City/State: CORALVILLE, IA 522412015 Sex: M History Information CLEAR DRIVING RECORD Name: Khalil, Mohamed A DL/ID: 739A39915 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: 44y�` pt9 q j2i >1ee:••••••'%Ag 10/9/2013 € Ztt) 'k CRServices ''...._ Iowa D partme tof Transportation Name: Khalil, Mohamed A DL/ID: 739,419915 Y Oct. 15: 20133 9:42AM, Div of Criminal rInvestigaation y No. 1295 rP, lit or STATE OF IOWA ;; i •- • %�A�\ Criminal History Record Check (` #. 1r= Se A .5 Request Form DCXAcoouutNdtnber: C O -F (if applicable) To: Iowa Division of Criminal Investigation B'romr CITY OF IOWA CITY 'Support Operations Bureau, l'lFloor )rRK 'S OFFICE 215 F.11i1'Street 410 E WASHINGTON STREET Des Moines)Iowa 50319 (515)725.6066 —.WWA--CtT,Y-10i3A 5-2-24A (515)725-6080 Fax Phone: 319-3565041 �'o,:- / Pax: 319-356--5497 I am requesting an Iowa Criminal History Record Cheek on: Last Name(mandatary) First Name(mandatory) Middle Name(recommended) • \<1&oX\L V\ 0\\6:\m 1\\ti\fn e_AA Date of Birth(mandatory)[ Gender(mapeatory) Social- ' Security Number(recommended) _ p / Male ❑Female l� P 6 / 2"5/ 1 1 v p l 0t — \2 " eipcs o Waiver Information:Without a signed Waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa, Chapter 692.2.For complete criminal history record Information,as allowed bylaw,always obtain a waiver signature from the subject of the request. _ Waiver Release:thereby give pctmisslon for the above requesting offs - I to conduct an Town criminal hIsloryrroord checkwith the Division of Criminal Investigation(DCI). Any criminal history dale concerning me Mai is maintain ytlia DCI may bo released as allowed bylaw. Waiver Signature: Iowa Criminal History Record Check Results (DCrnseonly) As of `,O l bJ' I 3 , a search of the provided name and date of birth revealed: • L No Iowa Criminal History Record found with DCI . ' El Iowa Criminal History Record attached,DCI ti ,. I/ DCI initials b /�./ Received Timenect10T 013 11 : 37AM No. 0902