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HomeMy WebLinkAbout15-089� r '. 401®4 maw CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497. FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO iS-M (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 3_ Contact Information (REQUIRED) Email'<Ar-1403� (14�1 Cell Phone: (31CI� 3 C (All written communicatiori'slent via email) 4a. Chauffeur's License expiration date (REQUIRED) �' C' , x� b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of ps 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?I \V Type of offense Where Whr 'tr APR 2 0 2015 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Othe' ' f- r,'tv, I( "3 Have you been arrested / charged with any traffic offenses in the last five years? y {� What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other _;___ 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ,tln`r 0 Type of offense Where When 9, Havg you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) IV � 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I h re�y�certify at I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 3 % 21, ( h f( issued on ,� n i,3expiring on C` C _ C 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) Signature of Applicant �� �11�6Yr� Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by fir, .Llr C. 1 I- tb..-,G on this ij- CO day of u. t _ WENI7Y S. MAYEtt ._ I Public in andlfor the State 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..tbe safety,,health,, or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). $ Signature T Chief or designee APR ; 0 2015 ((Date �CV,3 C,tv. to 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. THE EFFECTIVE DATE WILL MATCH THE CHAUFFEUR'S LICENSE EXPIRATION IF LESS THAN A YEAR. , ha Sig"n!4City CC or designee - Office Use Only Approved application DCI report State certified driving record Website update ate 01e-�d7w IDRIv AE)cenaPL92014a,,ded ooc 0212015 fillIOWADOT SMARTER i r�4APi_ERI f" MDRIVEN t;nAV,i0W8d0t.gOv Inquiry Date: 3/3/2015 Name: Truong, Trinh Cam Address: 1404 PRAIRIE DU Issue Date: CHIEN RD City/State: IOWA CITY, IA Date: 522455614 Mailing Address: 1404 PRAIRIE DU CHIEN RD Mailing City/State: IOWA CITY, IA 522455614 Convictions Office of Drivel Services PO Dor 9204 [ Des Moirfe5, IA 50306-3204 Pho-k: 515-244-9124 }890- 532-1121 1 Fax 5f6-239-1837 wwvs. towadt)t_g©Y Certified Abstract of Driving Record DL/ID #: 433ZZ6758(IA) Class: D Audit #: 6973210 Issue Date: 05/23/2013 Expiration 06/01/2018 Date: IIA Endorsements: 3 Restrictions: NONE Date of Birth: 6/1/1970 Sex: F History Information Customer #: 1542644 ID Status: None DL Status: VAL CDL Status: None CDL Cert None Status: IIA CDL Med None Status: Speed Restriction None Supplement: 11/13/2013 S92 ir Washington HA 10/05/2014 10/08/2014 APR 2O2015 Ciiif t,:e oV,2 C'tv IC; Citation Date Conviction Date ACD Explanation County ]UR 05/26/2012 .06/04/2012 S92 Speed (10 mph & under in 35-55 mph zone) Muscatine IIA 12/04/2012 '.12/11/2012 S92 Speed Johnson 'IA 11/09/2013 11/13/2013 S92 Speed Washington HA 10/05/2014 10/08/2014 592 ,Speed 'Johnson dA Name: Truong, Trinh Cam Dli 433ZZ6758 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: p ......... r`% �� 3/3/2015 IOWA ` y4' T.y►-, D. 0. if Office Driver BBIYEA$ of Services ,s���— Iowa Department of Transportation Var. 2. 201 4 12PM Dlv of Criminal Invesh—tlon .v I I I I .... VI1J VI 1VV2 i, ky F�Fd1nl P4eiViy� STATE OF IOWA 4 1 eco.ird Check 1 i01Y�1 ,1}T •� t. T0: Iowa Aivhloa of Criminal Invastipaon Support Operations Bureau, 1'n Floor 215 E. 7`^ Street Des moines, Iowa 50319 (515) 735-6066 (515) 725-6080 laau No, 1480 ? 6/6 no. )017 r, I DC1 Account Number. --�Ld b — r (frapplicsble) Fturn: C1CW oflowa Clt City Cleric's Offlee 410 )�. Washington 5ttert Io1va City, TA 32240 I` Phone; 319-356-5041 Fax: 319-356-5491 7TM5 OXI ua: only) As of 3 a search of the provided nnma.and date of bitch revealed: P' No Iorxra Criminal History Record found with DCT ❑ Iowa. Criminal Historykreord attached, DCI#__�� DC1 initials �•�;r_77 M/2i/i Q) Received l me Feb. 26. 2015 4:40PM No, 1294