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Home My WebLink About14-131 . Authorization Number 1 / A 1 0 1 (Office Use Only) CZPITATt-tillit ftt 4:117r APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE 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 First Middle Last 1. Name bat F 1rD/ \`),L C t^ SHC- k.1-4 2. Mailing Address 2I Q( *IBO > -(ower ci I/' , TA '2 c-) 3. Telephone: Home ti 7( 1-6(\160 L Other: 4. Prior experience in transportation of passengers: f `i tav- a�rwi+�c c.t\-4.4:‘ \Y\ 3 sti-mk 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ".10 Type of offense Where When '1a38iairi10�'�� . §� oroa vM -0_ 1 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? /\;'.1i Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /N L. Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? JN 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) cler Wtaxidrivbadg 03/2014 • I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 70 2 A 5. 4 2 8 5 . 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 Date6�-'6 /201,1 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 S.p,'.(' 5(,,.e , KI„ On this ,3p. day of Nj Q anl4 . WENDYS.MAYER o o ! .,.: Notary Public in aid for the State o owawa ' cion Expires ************************************************************************************************************************************************ 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 •sidents • e City of Iowa City(Title 5, Chapter 2,City Code). Si040P g - . e of ;,. :111 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. Signature of City Clerk or designe Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/2"(width)and 51/i" (height)and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update deddtaxidrivbadgeapp2014.doc 03/2014 Cr Jan:45. 2014 3• UOPNM Div uutiri rof vori ul Investigation uij� aV ? NNo.i3511 FP . Ll/1 u.e. STATE OFI CDWA L �,,.a „oFiya ��,��.n.�.r<•n ,, G • • J/':. 4.. . P• �' •t, : • aiming History Record'(leek `:if,,z `t' • ,,` s,•' li Request Forum • {�Ww,r F_ • • DCIAccountNumber: 400? `F (ifapplicahtc) • To; Iowa Division of Crimin al Investigation • Froml City of Iowa City Support Operations Bureau,In Floor City Clerk's Office 215 E. 714 Street 410 E.Washington Street • Des Mfoines,Iowa S0319 • . (515)725-6066 Iowa City, IA. 52240 (515)725-6000 Fax Shone: 319,356.4041 )!'Axl 319-356.5497 I am requesting an Iowa Criminal History Record Check on: Last Name (ntendaloq) First Name(niandntorJ Middle Name(reeonlmended) L 5Hc- skk ' Of1r el.. bAWLA ESrMALL Date of Birth (mandatory) Gender(m�(mandator') Social Security�jjNumber(rcconuncnded) Na /197 \ 76 L1d1V1ale Oi elnale 9, k O S 5 6 6 7 1- Waiver Information:Without a signed waiver from the subject of the request,a complete criminal history record may not bo releasable,per Code'ofIowa,Chapter 692.2.For complete criminal history record lnformodon,as allowed by law,always obtain a waiver si!nature from the subject of the rem mat. Waiver Re1 ase:1herebygivepermissionforNeaboverequestingofficialtoconduceanIOWAorl'nineililsloryrccord°heckwiththeDivision°MCanliaal Invrailgaticn(0C9, Mycriminalhistowdataconcerningmethatisn :baainedbyrheDClmaybereleasedalallowedbylow, ' . ' ' Waiver Signature: I. Wit. . 1 • 1m,, . gowa Criminal History Record Check Results • • (oclrlseomit As of G-25"II N , a search of the provided name and date of birth revealed: tAl No Iowa Criminal 1'Iistory Record found with DCI . ^' El Iowa Criminal l"IistolyRecord attached,DCI# _ ::.i DCI initials ibw• • Received 7Tme7Jun 23, Q2014 1 :05PM No. 3192 aa SMARTER I SIMPLER I CUSTOM ER DRIVER VsM'VV,EO�f11 dt :C CV Office of Driver Services PO Box 9204;Des Moines,to 50306-9204 Phone:515-244-9124[800-532-1121 [Fax:515-239-1837 wwwv.iowadot.gvv Certified Abstract of Driving Record Inquiry Date: 6/26/2014 DL/ID#: 702A34285(IA) Customer#: 6104420 Name: El Sheikh, Self El Dawla Class: D ID Status: None Ismai Address: 2401 HIGHWAY 6 E APT Audit#: 7024285 DL Status: VAL 1807 Issue Date: 06/11/2013 CDL Status: None City/State: IOWA CITY, IA 522406710 Expiration Date: 11/12/2018 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2401 HIGHWAY 6 E APT Restrictions: NONE Restriction None 1807 Date of Birth: 11/12/1976 Supplement: Mailing City/State: IOWA CITY,IA 522406710 Sett: M History Information CLEAR DRIVING RECORD Name: El Sheikh, Seif El Dawla Ismai DL/ID: 702A34285 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: o1yeq• ��xiitE�r4 OQ' . ....,/G�4 6/26/2014 141 IOWA ,01 PN.D. O. T :mss sir _ _ erst- ,yl'11*oRiutss c OfficeofIowa Driver Department of Services Name: El Sheikh,Seif El Dawla Ismai DL/ID: 702AJ4285