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Home My WebLink About18-087• � r i CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX Last 1. Name (REQUIRED) 2. Address (REQUIRED) _ 3. Contact Information (REC IDENTIFICATION NO. /f�—D VJ (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) Failure to complete the 'required" information will result in denial of the application 4a. Driver's License expiration date (REQUIRED) 61- of • D1 - I I b. Taxicab Business Name (REQUIRED) bicla n Tbt- Ccv� 5. Prior experience in transportation of passengers: Ye�� S I 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? I✓ CS Type of offense Where When 0,.w m 7 C-) What happened to the charge? (Circle one) r^ S Convicted Dismissed Deferred Suspended Plead Guilty =Dtl�ier N 7. Have you been arrested / charged with any traffic offenses in the last five years? Y e �J a Type of offense Where When 4'' 1" 'Z"y S'l �"A JLkwS w,n �a k...� O'f ^1Zl LoIS %1 3 1 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended leadGuilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the las five years? 1g U 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) N C= )2 (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 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). I hereb certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number g,6�YK g6C 6 issued on c °I c8 2a S expiring on o t- o i J �i � . I understand that if I falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver 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) 4� Signature of Applicant t=-- J Date beq— c _r n� t -�� _cm-° rn 1\f\R1\R\f\\R\\1\1\'Y11,!}f\fMNM\\f\R\\\11fY41 N\ STATE OF IOWA COUNTY OF JOHNSON ) y' N Subscribed and sworn to before me by y \ r 0. , on this 24 day of */t1tHRlRflfkfRRRRiM#fI(#*HeR4itR1,�Itlflflf,RRfRHiMRRlRiifRHRRiMRifRRRNRRRRtlRlR4ki Rill*fIt1,RR41iRRRRRRR4RRRMfYtfR\IPPR 713 �O 1eRRRfRN I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Driver's icense of -al- Z°'f h a-zy_ Z-0 /1P Signa u Police Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. �j Signat re of City Clerk r esignee Date \\RMRIRtRt}R\\\\\f\\\RRf\1RR\\ff\R}t\RRRH\\\\\\\Nf\f\\\ff1\RMRiRf\f\f1f\lHtii\iN\:fI\\\R\\1\\RiHtky\\y\\1\f\\fRRR}R\\\}\\\\\\y\\\\ Office Use Only Approved application DCI report State certified driving record Website update CIWr AXIDRNBADGEAPPL920188�.DOC 04/2018 C410WADOT SMARTER I SIMPLER I (USTOMER DRIVEN WWW'IOWBdOLgOV Drtwr & isaMlflowon forvlon PO Box 82011 Dn Montes, N 50309.9201 Phone. 515.24491241 Far: 515-2331937 Certified Abstract of Driving Record Inquiry Date: 8/23/2018 DL/ID #: 809AK8656 (IA) CDL Permit Class: None JUR County Customer #: 6227659 Class: D CDL Permit Issue None IA Johnson 11/25/2016 02/07/2017 M14 'Fall to Obey Traffic Date: N Johnson Name: Kirja, Kamll Hassan Audit #: 9403765 CDL Permit None W Expiration Date: 3M, Address: 1913 GRYN DR Issue Date: 09/08/2015 CDL Permit '>Qpe C -- Endorsements: 9-4 Endorsements: N ,� Expiration 01/01/2019 CDL Permit C Wb;e F ' Date: Restrictions: �n rt"� rn City/State: IOWA CITY, IA 522464408 Endorsements: Chauffeur 2 ID Status: -4J Mailing 1913 GRYN DR Restrictions: NONE DL Status: = Address: Restriction None O` CDL Status: 40orllP n: Mailing IOWA CITY, IA 522464408 Supplement: CDL Permit Status: EIG City/State: tV Date of 1/1/1975 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation JUR County 03/17/2015 04/21/2015 M14 Fall to Obey Traffic Sign/Signal IA Johnson 11/25/2016 02/07/2017 M14 'Fall to Obey Traffic Sign/Signal IA Johnson Name: Kirja, Kamll Hassan DL/ID: 809AK8656 (IA) Pursuant to Iowa Code §321.10, 1, Darcy Doty, Driver & Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by Driver & Identification Services, that this Is a true and accurate copy of an official record currently In the custody of said office, and that 1 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: 8/23/2018 A212 VL AOto-- oQ �ggyi ooc�Mca� Driver & Identification Services Iowa Department of Transportation Name: Kirja, Kamil Hassan DL/ID: 809AK8656 (IA) Aug -ZZ. LUIS IZ;4ZYMUiv of Criminal Investigation Fra........., ._..._ _. , Clor.. _•_ ------I 06/17/2016 n6:1No. 0201164- P'.4/J`rG02 STATE OF IOWA � Criminal History Record Check Request Form ' DCI Account Number: ttup�_ (� (if applicable) To: Iowa Division of Criminal Investigation From: City of Iowa City Support Operations Bureau, l" Floor City Clerk's Office r 1 215 X 7'h Street 410 B. Washln Lor1.,Slreel o Des Moines, Iowa 50319 v a r (515) 725-6066 Iowa Cl �n C AA 52 (515) 77.5-6080 Fax ty, �t � --).< N 1— Phone: 319-356-5041 .1i:- Fax: 319-356.5497 -<rn -o I am requesting an lolva Criminal Histody Record Check on: tw Last Nape (mandatory) First Name (mandatory) Middle Name ("natimended) Date of Birth (mandatory) Gender (manaamry) Social Securi Number (recommmdea C/- o /- 7�S 9male ❑Female p — 12-- 9 8 2 Waiver1gformafion. Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed by law, always obtain a waiver signature from the subject of the request. Waiver Release; 1 herebygive permission for the above reriurs(ins oniciel to conduct an Iowa criminal history record check wigs Ihet)Msion of Criminal Inves6gation(DO). Any criminal hiswry data conamina meabat is maintained by lho DCl may be releaud or allowed bylaw. WaiverSignafure:_ - Iowa Criminal History Record Check Results As of. 22' 1$ , a search of the provided name and date of birth No Iowa Criminal History Record found with DCI ❑ Iowa Criminal history Record atteQhed, DCI #.. DCI initials ola►_1 DCI -77 (08/15110) r•tc�