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Home My WebLink About13-236 ) • Authorization Number 13 -- a3 �Q _ 1 (Office Use Only) CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington Strcet between 8 a.m.to 3 p.m., Monday—Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX / / First r;/ Middle MO(law e0 oct Last /a zO 1. Name r 1"I 11 2. Mailing Address Lf° t ��rI1 t1 rid - 2 c> IToCJQ 62 , I A f 3. Telephone: Home (3 1.9) Cf 7/ — 1 Z 3%r Other: /L./031e. 4. Prior experience in transportation of passengers: e- ;?ice` 4e fX1 P/L2ii( • 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ' r40 ' `' 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? /V 0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? y e Type of offense Where When ret7c.,c TOVi nSO Cc7L(ni j /0 —/y — ,� OCA cj 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /J U 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) N0 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) clerMaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number t o .4. (4(11` . 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 a of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) 2 Signature of Applicant-- / Date /0' .�-'e20J3 STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by L, t d( M Ac �a.uZ-c.. . On this o/u'LC. day of oc , 14'011 1..c5S d� WENDY S.MAYER Notary Public i and for the State of 16wa t,om-nrraion minnow l air .J:****,,** **** *****`*** * **********************************:F******************************************tic********at*******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). Signe of Poll e�' 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. 2 rL z✓ /S kQ-14/ / d i/- Signat re of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/z" (width)and 5'/Z" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update • aer! taxldrivbadgeapp2o1o.doc 03/2013 1,11 (S.ep. 30. 2013 9: 05AM Div of Criminal Investigation No. 7555 P. 1 , P. STATE OF IOWA. , N ' Criminal History Record Check -''`- �'.11t2l't;101 '•)11' Request Form DCI Account Number: goo 2-r- (itappllcablc) To; Xowa Division of Criminal Investigation From: CITY OF IOWA CITY Support Operations X3ureau,Xat Floor 1' 9: .. i"''ICE 215 F 7jb Street 410 E WASHINGTON STREET Des Moines,Iowa 50319 (515)725-6066 .-IOWA CITY IOWA 52240 (515)725-6080 Fax • Phone; ,319-3565041 rax: 919--356-5497 I am requesting an Iowa Criminal HistoiyRecord Check on: Last Name(mandato0) First Name(mandatory) Middle Name (recommended) K gLKheir Mohamed Amiaa Date of Birth (mandatory) Gender(mandatory) Social Security Number(recommended) /0 ~ 2 — / 9 7083❑1♦omale 83 21- 26 93 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.Per complete criminal history record information,as allowed bylaw,always obtain a waiver signature from the sub(ect of the request. Waiver Release:I hereby givepermisslon for the o•ova requ sting official to conduct an Iowa criminal history record cheek with the Division oPCrinlnat Investigation(DCO. Any criminal history,data concemi ,me that'.maintained bythe DCl may be released as allowed by law. Waiver Signature; //r/ Iowa Criminal history' Record Check Results (DCluseonl, n As of `7 3d---t3 , 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# n, • • DCI initials• '�/ • DCI-77(08/25/10) Received Time Sep. 25, 2013 1 :42PM No. 7274 Iowa Department of Transportation 01) Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAC:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 9/19/2013 DL/ID #: 346AE4411 (IA) Customer It: 4810504 Name: Hamza, Elkheir Mohamed Class: D ID Status: None Awad Address: 2401 BARTELT RD APT 2D Audit It: 4442025 DL Status: VAL Issue Date: 06/17/2010 CDL Status: None City/State: IOWA CITY,IA 522462701 Expiration Date: 10/02/2014 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2401 BARTELT RD APT 2D Restrictions: NONE Restriction None Date of Birth: 10/2/1970 Supplement: Mailing City/State: IOWA CITY,IA 522462701 Sex: M history Information Convictions Citation Date_ _ __ Conviction Date ACD Explanation County JUR 08/15/2009 10/14/2009 ,S92 Speed Johnson IA Name: Hamza, Elkheir Mohamed Awad DL/ID: 346AE4411 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: Ate' ,/p q 9/19/2013 / 14t IOWA :s% 40: •a r , I11 4t&AIVEA it, Iowaeof Driver Services Department ry Transportation Name: Hamza, Elkheir Mohamed Awad DL/ID: 346AE4411