The URL can be used to link to this page

Home My WebLink About13-231 Authorization Number /! ` .1-3) I - 1 (Office Use Only) 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 F+rr e Iddle� Last n 1. Name ��(/�[r l� 1`�,oc1; �J )i CXc h7VI c 2, Mailing Address Z 5 CD O 6 ,,,,,,,te_(� 'Rd, 14 4 3. Telephone: Home L 2 _w�3-2 g Z Other: 4. Prior experience in transportation of passengers: (1A) U V\kC:___ . a W r i ' '-(1/67A c_f-,r,,,��.. \ 'cI S t tk r u.t1 a a. ,V1,i d4-0 4 r G til-Sr va )\-Ke_7t.v, ,a_.,J o, r 61 vtA 4 0/-1 J06 .,., . 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where _._. When N ( A 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 1\(- i / C 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When c t (/k //A8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N Type of offense Where When 17 \ 1 9. Have you ever applied to be an Iowa City taxi driver using 2ent name? If yes, please provide the name(s) is,,,j 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) clerkAaxidrrvbadg 03/2013 i . I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 5.S.4 A f,- l . 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 tim I 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 l 0 5 24 / v STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn lo before me by 5 ,.„n't r u m r cD q.6 . On this J d-� day of oma.. ,�0 5 > 45644 WENDY S.MAYER Notary Public i nd for the State Iowa 2 s mml on r ' My Commission Expires My 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). ignatuie of Police 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. 2 i k . 1 ,/.:=.,./11 Signat of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/Z” (width)and 5 '/2" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update GerWlaxidrivbadgeapp2010.doc 03/2013 Sep. 20. 2013. 4: 25PM Div of Criminal Investigation No. 8574 P. 3/4 •u,v.. iif. toll t.Juul Ur Ir UI el n UI ly (it Lund bI tV Ire. JYUJ F. L • <ii�a ,;„„ STATE OF IOWA - t'YtQrrf��`/ .01 itY44� Criminal }lhsto>ry Record Cheek • YL,;` ' .:;�`: T::1 1:equest Form t- : �:r�- DCIAccountNumber: t4o19 —F.' Of To: Iowa Division of Criminal Investigation From; City of Iowa City Support Operations Bureau,la Floor City Clerk's Office 215$,7j''Street 410 E.Washington Street Des Moines,Iowa 50319 (515)725.6066 Iowa City, IA. 52240 • (515)7zg-6o8o Fax phone: 319.356.5041 Fax: 319-356.6497 I am requesting an Iowa CriminalHistotyRecord Check on: Last Name (nlmtdetory) First Name(nsendalory) Middle Name(recommended) (; I dahn/Ikea SIat/Ki k- 1\A' a M/lf__d Date loft Birth(mandatory) Gender(mandatory) Social Security Number(recommendded) 1 2 !p `_I f1Vfale ®Female 3 5-1 -(71 tir. d g 75 Waiver Infoi'fnal'low Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of/owe,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:Ihereby give permission for the oh ova requesrtng official to conduct an Iowa edniInal hi,tory mad check with the Division of Criminal Irma igarion(DCI). My criminal history dela coneemingr.t�attained by the DCI may bo released s allowed by law. 1/4 Waiver Signature: fie. 1l u.,lt Iowa I Criminal History Record Check Results (DCI laeonly) As of 4 L O , a search of the provided name and date of birth revealed: • p No Iowa Criminal History Record found with DCI • 0 IowaCriminal History Record attached,DCI# -DCI initialsp Received TirrCSerQ, lA. 2D13— 2: 31PM1o, 8158 • • • C Iowa Department of Transportation jig, Office at Driver Servicesdr (toll Free)800-532-1121 PO Box 9204,Des Manes,LA 50306-9204 515-244-9124 FAX:515-239-1637 Certified Abstract of Driving Record Inquiry Date: 9/26/2013 DL/ID#: 532AG5413 (IA) Customer#: 5846338 Name: Sidahmed, Shakir Class: D ID Status: None Mohamed Address: 2509 BARTELT RD APT Audit#: 5450123 DL Status: VAL 1D Issue Date: 08/17/2011 CDL Status: None City/State: IOWA CITY, IA Expiration 04/20/2016 CDL Cert None 522462715 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2509 BARTELT RD APT Restrictions: NONE Restriction None 1D Date of Birth: 4/20/1957 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522462715 History Information CLEAR DRIVING RECORD Name: Sidahmed, Shakir Mohamed DL/ID: 532AG5413 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: .14. 4. ........7,11:41, y 9/26/2013 �: IOWA :si a e zz f 50; :A t3 D. 0. T. a lt. h16F� 0 � Iowa D partme teof iTransportation Name: Sidahmed,Shakir Mohamed DL/ID: 532AG5413