The URL can be used to link to this page

Home My WebLink About15-030 „ Authorization Number / ., — a'; L (Office Use Only) :VIII amsamiglir APPLICATION FOR TAXI/ MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday—Friday.) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required”information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX First Q s y� t, Middle Last Pc 1. Name (REQUIRED) 2. Mailing Address (REQUIRED) 6 1 ALlR R J \ (9 T A- I (3-um r I4y 5,121.{1 3. Contact Information (REQUIRED) Email: }--S f.I,d 1..2.Jt-/ (5) 14 of_ -co Ni Cell Phone: 3`r1 - -'7 if 3 4. Prior experience in transportation of passengers: 72;V vLK.- 5. 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?. -- Type Type of offense Where 1,11Ptei . w i• 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? NJ) Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Ai .T Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _/7 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) 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) 09/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number !. At) 3 u- . . 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 (q0 h d 4. Date 31 9 — c•f 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. STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by _,. r , A \ , . On this r?-* day of viiENoY S.MAYER Commission Nw.Nr72M2$ Notary Publi.E and for the S : e of to a 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). Signature of P ief or designee Date 1 YOU ARE(NO VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OVICE. Authorized taxi driver names are placed on the city website at icgov.org. ' ,fe! ,/vI7• 4/Ai Si nat e of CityClerk or designee ateD 9 9 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 Clerk/TAXIDRIVBADGEAPPL92014amended.DOC 09/2014 iFeb. 4. 2015 10:44AM (Dive of Criminal min vitrInvest igation, NNo. 0198 P. 2/2 LVIJ es. U. JIM OF IOWA 1' �+ v�1 cj Ceiba incl History "awed (Check. `a "r,;, 11• �'; Request JForlIh `', ;"/ ''��nvr.+n.'.^' 11 DCI AccountNwnberf yoog-F (if applicable) To: Iowa Division of Criminal Investigation from; City of Iowa City Support Operations Doreen,ltlFioor City Clerk's Office 215 E.7th Street 410 F.Washington Street Des Moines,Iowa 50319 (515)125-6066 Iowa City, IA 52240 (515)7254080 Fax Phone: 319.366-501 • Fax: 319-d56.5491 I am requesting an Iowa Criminal History Record Check on: • Last Name(mandatory) First Name(mandatory) Middle Name(recommended) AL; Rask el Nool tit-R 4h Date of Birth(mandatory) Gender(mandatory) Social Security Number(recommended) -- F - 117 5 I2Male i.--lFemale 3 5 4 - 9 q - 1 i g s Waiver information: Without a signed waiver from the subject of tha request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692.2.For complete criminal history record information,es allowed by law,always obtain a waiver signature from the subject of the request. Waiver•Release:I hereby alvo permission for the above requesting of olal Co conduct an Iowa criminal history record ehcdc Willi the Dlvhlon ofCriniinel Investigation(DCI). Any orlmUrot noon,data conccrnatamethat is maintained by the DCI may bo released arallowed bylaw. Waiver Signature: Pg lj t d A L'• 1� �tSr—•rCr Iowa Crimilkal History Record Check Results (Daus*only) As of a 1145 , a search of the provided name and dato of built revealed: • No Iowa Criminal History Record found with DCI • 0 Iowa Criminal History Record attached,DCI# r•1 DCI initials btu • Received Timgg1g6,„3;12015 3:08PM No. 9526 o Dot vvvvvv,iovvadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 I Des Moines,IA 50306-9204 Phone:515-244-9124 1 800-532-1121 I Fax:515-239-1837 www.iowadoigov Certified Abstract of Driving Record Inquiry Date: 1/23/2015 DL/ID #: 742A)3541 (IA) Customer#: 6124543 Name: All, Rashid Abdlrhman Elzber Class: D ID Status: None Address: 2606 BARTELT RD APT 2A Audit#: 8787379 DL Status: VAL Issue Date: 01/23/2015 CDL Status: None City/State: IOWA CITY,IA 522462729 Expiration Date: 01/01/2020 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2606 BARTELT RD APT 2A Restrictions: Corrective Lenses Restriction None Date of Birth: 1/1/1975 Supplement: Mailing City/State: IOWA CITY,IA 522462729 Sex: M History Information CLEAR DRIVING RECORD Name:All, Rashid Abdlrhman Either DL/ID: 742A73541 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: .ay\ 111 ti; IOWA%-ocbe %.,�'? ,AA�. �, T IA! 1/23/2015 Office of Driver Services Iowa Department of Transportation Name:All,Rashid Abdlrhman Elzber DL/ID: 742A33541