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Home My WebLink About13-245 Authorization Number l - a 5- (Office Use Only) • -,--erop47.•...-Ait agovvis asuciouqr 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 l 1. Name � S�?�d �ci) oI I V\ E157 2. Mailing Address 7 M a 55 ttl o of //Ai /0c..va ('r f7 / ff 52 24 6 3. Telephone: Home 3 Jci 3 3 36.2 ''6' Other: 4. Prior experience in transportation of passengers: 46?h7.P1r/Ccv� /CrXI Cr4) 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /lO 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? A/0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /u Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /I/c) 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 D 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) derkfaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license nr: nber CLiLu�ir�f� X24 Ch 6 . 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 /6//1-i I / 7 STATE OF IOWA COUNTY OF JOHNSON ) subscribed and sworn to before me by Y . On this \y k-L, day of .' No blic in and for the State of Iowa _7 13 )9 **************************************************************************.*******.************************************************************* 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). Agnatur Police Chief or designee ,y�nate 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. /13 Signat of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 51/2" (height) and prominently displayed to all passengers. .******************..****.*.*********************************************************************************.********************************** Office Use Only Approved application DCI report State certified driving record Website update clerkttaxidrivbadgeapp2010.doc 03/2013 Or Iowa Department of Transportation #.. Office of Driver Services (Toll Free)80032-1121 PO Box 9204,Des Manes,IA 5030!-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 10/1/2013 DL/ID#: 122AC6636 (IA) Customer#: 4319145 Name: ElsId, Elrashid Class: D ID Status: None Address: 325 MOSSWOOD LN Audit#: 5867668 DL Status: VAL Issue Date: 03/20/2012 CDL Status: None City/State: IOWA CITY, IA Expiration 08/16/2014 CDL Cert None 522466114 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 325 MOSSWOOD LN Restrictions: NONE Restriction None Date of Birth: 8/16/1968 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522466114 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 03/25/2011 04/11/2011 592 Speed Johnson IA Name: Elsid, Elrashid DL/ID: 122AC6636 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: Fe," -"•:rip+ 10/1/2013 ccz: ) 4o, + • „p� ces Of�RIY S I IowaDepartment of eof Driver eiTransportation Name: Elsid, Elrashid DL/ID: 122AC6636 116. Oct. 3. M 2013 4: 26PDiv of Criminal Investigation kv:J/0016 I. L. JV ,..t. iv 4. 2 M ivn vi ,vnu vi vy Y STATE OF IOWA ,i..y'",\t ..io:. \` Criminal History Record Check !' h . " 'A Request Form ` .- ':\Nies.:! �'noy„sr^ 'i11ns DCI Account Number: titp�-F . (If applicable) To: Iowa Division of Criminalluvestigation From; CITY OF IOWA CITY Support Operations Doreen, 1"Floor CITY CLERIC'S OFFICE 215 E.7th Street 410E WASHINGTON STREET Des Moines,Iowa 50319 (515)725.6066 IC • ! • a (515)725-6080 Fax moue; 319-3565041 Fax; 319--356-5497 I am requesting an Iowa Criminal History Record Check on; Last Name (mandatory) First Name(mandatory) Middle Nance(rccommcndcd) a".'.5 id -/1--a Mid' 77,"e4 ah Yi Date of Birth(mandatory) Gender(m)ndotory) Social Security Number(rccommcndcd) $//S/19 6 8 Wale ❑Female 22 4 13 e s-n• Waiver Information: Without a signed waiver from the subject of the request,a complete criminal history record mny 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 sublect of the request. Wa(per Release;i h:rcby give permission fordo) boyo r)quesling oincIal to conduct an Iowa criminal history record check wall Division of Criminal Investigation(DCI). Any criminal hislory dale eonccmingpme that Is maintained by too Da maybe released as allowed by law. Waiver Signature: _ 01-Cas. US.11. p.... Iowa Criminal History Record Check Results V 1(FOCIusecrib) As of i n- j , a search of the provided name and date of birth revealed: • No Iowa Criminal History Record found with DCI 0 Iowa Criminal History Record attached, DCI# DCI initials C l) . Received Tirie7Sep. 30,O'2013 8:35AM No. 7549 •