HomeMy WebLinkAbout15-029CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-1826
(319) 356-5040
(319) 3S6 -S497 FAX
1. Name (REQUIRED)
Atrthorization Number.) `�j
(Office Use Only)
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APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.)
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First .
2. Mailing Address (REQUIRED) U
3. Contact Information (REQUIRED) Email::13-6
4. Prior experience « ati of passengers.
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
T e of offense
Where
6. Have yon convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? u ee
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense
Where
When
r�=
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
Type of offense
Where
When
9. applied 1e to bean Iowa City taxi driver using a different name? IfYes, Please p rovlde the name(s)
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DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTI „f D
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW,- ,
You must apply for an individual Department of Criminal Investigation Report (form available up" requ?*).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
09/2014
I,heby cerb have issued to me by the Iowa Department of Transportation a valid Chauffeurs (cense number
{ `r} / . 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 recor and documents relating to this application, and I further agree that, if a license
is granted, to comply at all ' w' I o h rovisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public) 1
Signature of Applicant \ Date
YOU ARE NOT VALID TO DRIVE A TAXI IWOWA CITY UN-Fli"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
COUNTYOFJOHNSON )
Subscribed and sworn to be(_Ofore me by .u° a Y r o � . e. \ �' On this v._.... day of
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).
Sign at of PoI75lfief 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.
>.
Signa re of dquerk or designee
Date ,.
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %1' (width) and 5'/:"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
ClerWTA%IDRIVBADGEAPPL82014emerded.DOC 09/2014
02/Feb. 4. 2015910:52AM Div of Criminal Investigation
STATE OF IOWA
,iCriminal Matery Record Cbeck
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