The URL can be used to link to this page

Home My WebLink About14-207 Authorization Number (1— l 1 i 1 (Office Use Only) :.®fir :cul % .ga 10410 CM I Air APPLICATION FOR TAXI I 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 Middle _ Last 1. Name (REQUIRED) 04 f I J� SPLA} t_Lbik) pi 1j-4 2. Mailing Address (REQUIRED) 2C1Ij firtle.C1 Poi, roJc, k ; /o ci S22C4 3. Contact Information (REQUIRED) Email: k,.uri r✓IVYIcrki 2-0f l j4kp,Cell Phone: 7 I - o51/ 4. Prior experience in transportation of passengers: 9. c rS r I V'C' ( crY \f'e/to uk3 Cq.b bCc(ic,c 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? IV 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? 0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? N 0 t ; ,- n!Type of offense Where Men] Eflo —ri N to rn 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five yeai*:: : NR) 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) No 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 S - Kq C, . 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 770-' De - 1\k(NlaY Date CI I () ( 20 I L1 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 ,1-1,:kti yk. S . -- . -Lc 'cL . On this t ) {1 day of • ,.A 1/4,-ski s WENDY S.MAYER ' f t Cnmmieeinn NIImhAr 79C1477/1Notary Public in d for the Sta ,-47f Iowa My Commission Expires ow 4 i-?3 1 Le 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). q7/2'//Y Signature oli ief or designee Dat 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. 74 0=-2-- Sign e of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/2" (width)and 51/2" (height)and prominently displayed to all passengers. .-r = Y Office Use Only Lu _Qt W>= L)1- Approved appacatioiaz >. DCI report"—• t—< State certiflerlirivinecorB Website update - CP ClerkrFAXIDRNBADGEAPPL92014amended.DOC 09/2014 .Sep. 10. 2014 6: 32PMDiv of Criminal Investigation No. 9366 P. 7/8 ocp. ...). to 14 e. 00Ini City t, Ie: n — UIty of reed UP 0, No. 71ro P. L . • • ' • org.% STATE OF IOWA • r� � . : :t y , , r r f s ' nCrotga1' Criminal History � a . Ruest Porn V :ii • DCT Account Number: Li non.-F • (ifapplicable) To: Iowa Division of Criminal Investigation From: City of Iowa City Support Operations Bureau,1"Floor City Clerk's Office 215 E.Stn Street 410 E.Washington Street• Des Moines,Iowa 50319 . (515)7254066 Iowa City, TA 52240 (515)725-6000 Fax Phone: 319-356-5041 • Pax: 319-3565497 • • I am requesting an Iowa Criminal History Record Check onl • Last Name (handetory) .Era t Name(otendobry) Middle Name(recommended) nit 0i ar I4oi1- ► . . Date of Birth(mendamry) Gender{mandgtoy) Social Security Number(recommended) 0/7/ 26//974 kale ❑rtemale / 3m - 9 % - C(Si Waiver Information:Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,par Code dun's p,Chapter 692.2.For complete criminal history record iaforrriation,as allowed by law,always • obtain a waiver signature from the subject of the request, . . Waiver Release:thereby gheepermission for the above regutoling offiolal le conductanTowecriminalhrslotyrecordcheckwilhthcDivisionofCriminal • 7nvudgallon(DCI). Any criminal hislay data concealing nm that Is maintained Write DCI may be released as allowed by law. �^�'r• r V / A�-^- • Waiver Signature: — iA A v40 , _ _.!y. �l l . IowaCriminal History Record Check Results moi ;,.ea» ty) A.s of "6-I o-1 y , a search of the provided nenne and date of birth revealed: . . •, 1 • !.- ..` No Iowa Criminal History Record found with D CT o r i• .• J • 0 Iowa Criminal History Record attached,DCI# DCI initials 460 • Received iimey;Sepi„3;2014- 2:55PM1o. 8592 - Iowa Department of Transportation Jo Office of Driver Services (Tol9 Free)800-532-1121 PC)ilex 52134,Des Moines,IA 5630642N 515.244- 124 NinoSAX:515.239-183i Certified Abstract of Driving Record Inquiry Date: 8/28/2014 DL/ID#: 837AK9386(IA) Customer#: 6147179 Name: Matar, Hatim Class: D ID Status: None Salaheldin Elnour Address: 2411 BARTELT RD Audit it: 8379386 DL Status: VAL APT 2D Issue Date: 08/21/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 04/26/2019 CDL Cert Status: None 522462706 Endorsements: 3 CDL Med Status: None Mailing Address: 2411 BARTELT RD Restrictions: Corrective Lenses Restriction None APT 2D Supplement: Date of Birth: 4/26/1977 Mailing IOWA CITY,IA Sex: M City/State: 522462706 History Information CLEAR DRIVING RECORD Name: Matar, Hatim Salaheldin Elnour DL/ID: 837AK9386 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: r NOW 8/28/2014 4 i ks IOWA • ;i • D. O. T Ws llr7 URI1J.% �-' Office of Driver Services Iowa Department of Transporation Name: Matar, Hatim Salaheldin Elnour DL/ID: 837AK9386