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Home My WebLink About14-244 Authorization Number 11 '2-2}-11 A r 1 (Office Use Only) 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 4319) 356-5040 /4b.-2 (319) 356-5497 FAX .�1 1. Name (REQUIRED) W4-4_E-1- F1 /4IS‹4� Last 2. Mailing Address (REQUIRED) 60 1_n 1 oaks 1Z ApI- , iJo u-FA L1 Lee 3. Contact Information (REQUIRED) Email: Sea, o( 15 1 c teo. C Cell Phone:94. 112, 1 -170 9 4. Prior experience in transportation of passengers: J�S( fi & 1--pb1` \s a.. A down 'Cweiv\ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? +%.1-0 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? ,JO �.a Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years'? 1)6) ;moi,, a ri Type of offense Where Wtiert r> ,y f.+ 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? AI() 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) 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 ce that h ve ss ed to me by the Iowa Department of Transportation a valid Chauffeur's license number • . 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 (PM /I LI i. 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 Sntrk \ L--.V , __,L�-;c.-SS�u... On this �53f-k day of uc t-o Lt110S ,%1 i1 alar WEIVDY 1`o"..; `; Commission Number ee�729428 ,� '` ' Notary Public ' and for the State of owa wk. '1-1111• _.42 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). / / / Signatur'• of Poli'e V ie 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. ,/ �C �,,,.. ` - (11_/ /l, _ - / 2/ Signature oCity 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. Office Use Only Approved application DCI report State certified driving record Website update CIerWTAXIDRIVBADGEAPPL92014amended.DOC 09/2014 (Oct.-21. 2014 9: 22AM (Div of Criminal InvestigationNo. 3505 P. 1/1 V u L.'I V. L V 1 7 J.J V I III %.,11., v 1 4 1 m v i k r v l Lynn v l t r N N . J J L f P. L ;,‘ , STATE OF OWE l w`I[ . / ` , }C- �\\ Criial History Record Check , .%.• - 1 ...;'re town t Request Form vvi hrf.:I t•- 1 DCI Account Number: /o0.2rF (if applicable) To; Iowa Division of Criminal Investigation From: City of Iowa City . Support Operations Bureau,1"Floor City Cleric's Office ,.�, 215)E,71"Street 410 E.Washington Street r Des Moines,Iowa 50519 , o --11 tl (319)923-6066 Iowa City, Ili52149— A (515)725.6080 Hast . t—; ry -y Phone: 319-356-5041 =ic•-) a r Fax; 319-356-5491 =G r -~t -, t „i I am requesting an Iowa Criminal History Record Cheek on: Last Name mandatory) First Name mandato j Middle Nallle recommended EL HA55AN S4L4,1-1 Y4SSiqN Date of Birth(mandator)) Gender(mandatory) _Social Security Number(recommended) o 6 0 19.73 PMale ®Female 66 2 `- 60 o 6 o9 YYfltverinform :Ion:Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Cede of Iowa,Chaptor 69212.Vol complete criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request. Waiver Release:t hereby give permission for the above requesting official to conduct an Iowa criminal history record check with the Division of Criminal f nicstlgation(DCI). Any criminal history dale concerning me that Is malrualncd by the DCI maybe released as allowed by law. Waiver Signatue LA)DA4)1 UClit—'" Iowa Criminal History Record Check Results (DCI use only) As of 10: , a search of the.provided name and date of birth revealed: __ Et\ No Iowa Criminal History Record found with DCII _ El Iowa Criminal History Record attached,DCI# DCI initials hA I - Received Time'7Oc(. 16.f1r2014 3: 52PM No. 3229 . . • w w iowadot ov SMARTER t 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 1 Pax:515-239-1837 www_iowadot.gov Certified Abstract of Driving Record Inquiry Date: 10/17/2014 DL/ID#: 789AK7776 (IA) Customer#: 6203841 Name: El Hassan,Salah Class: C ID Status: None Hassan Beshir Address: 60 PENN OAKS DR APT Audit#: 7897776 DL Status: VAL 7 Issue Date: 03/19/2014 CDL Status: None City/State: NORTH LIBERTY, IA Expiration 06/08/2019 CDL Cert None 523179139 Date: Status: Endorsements: NONE CDL Med None Status: Mailing Address: 60 PENN OAKS DR APT Restrictions: NONE Restriction None 7 Date of Birth: 6/8/1973 Supplement: Mailing City/State: NORTH LIBERTY, IA Sex: M 523179139 History Information CLEAR DRIVING RECORD Name: El Hassan, Salah Hassan Beshir DL/ID: 789AK7776 Pursuant to Iowa Code §321.10, 1, 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: ........• 4f 10/17/201411.1 :' IOWA ® o stiff:D. O. T. ( Office of Driver Services �� Iowa Department of Transportation - c m -0 p i Name: El Hassan, Salah Hassan Beshir DL/ID: 789AK7776 N C�)