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Home My WebLink About16-044t � r t cccull �,®l• CITY OF IOWA CITY 410 East Washington Street lona city. lona 52 240-1 82 6 (319) 3S6 -504D IDENTIFICATION NO. I i9" 0 (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 (319) 356-5497 FAX First <el WV Middle Last 1. Name (REQUIRED) _fit 7 7- ""- / G�' L 9�y� L- 2. Address (REQUIRED) �✓ sT �.tuf:��[J �J�, _pu/q �� fes• j _57 3. Contact Information (REQUIRED) Email: yam'+Krim+—�3j�inka-,� Cell Phone:3� mac- =��%3 (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) AP ael -.W4C b. Taxicab Business Name (REQUIRED) (—',jr 5. Prior experience in transportation of passengers: i y 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? .Y,- g What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspende Plead Guilty other 8. Has your driver's license or chauffeur's license been suspended or revoked in teas ive years? -1112o 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 riame(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW t, You must apply for an individual Department of Criminal Investigation Report (form available upow inquest). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02!2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I here y certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number issued on ^ `LP4:?-xpiring ongt.a7(� . i6 I understand that if I falsely an of 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 Date3 r9 ,�� STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Sen _ ih it) C, t Ay -eA-, on this day of k VA -7-0 Zor U 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 th,,e.etty`of Iowa City (Title 5, Chapter 2, City Code). is license fl &91 J7 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. �CdiLttZ re'* Y� 7�I-G� Signattrre of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date. _ _ }1 CeerW AXIDRw6ADGEPPPL92al 4aniended. DOC 03/2015 C410WADOT SMARTER i 5IMPLER 1 CUSTOMER DfUVE14 V1tYVw.IU adt3LQOV Office of Driver Services PO Box 9204.1 Des Maines, 145030&,9204 Phone:515-244-91241811ID-532-1121 [ Fax: 515-239-1837 wwiiir Kiwadsotgov Certified Abstract of Driving Record Inquiry Date: 3/2/2016 DL/ID 7f: 662YY1237 (IA) Customer R: 1895748 Class: D Name: Nguyen, Son Minh Audit 0: 6884444 Address: 2557 INDIGO DR Issue Date: 04/23/2013 .i j ID Status: Expiration Date: 08/01/2016 City/State: IOWA CITY, 1A 522406824 Endorsements: 3 Mailing 2557 INDIGO DR Restrictions: NONE Address: Restriction None Mailing IOWA CITY, IA 522406824 Supplement: City/State: Date of Birth: 8/1/1966 Sex: M History Information Convictions CDL Permit Class: None CDL Permit Issue None Date: JUR CDL Permit Expiration None Date: S92 CDL Permit None Endorsements: 11/26/2013 CDL Permit None Restrictions: .i j ID Status: None DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation County JUR 01/30/2012 .. 02/20/2012 S92 Speed "Johnson IIA 11/26/2013 401/06/2014 7S92 _ _ - ,Speed ....._ .i j � Iowa Department of Transportation 04/05/2014 }05/06/2014 :592 ._... 'Speed (10 mph & under in 35-55 mph zone) .Scott !Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 02/19/2012 X675679 !IA Name: Nguyen, Son Minh DL/ID: 662YY1237 Pursuant to Iowa Lode §321.10, 1, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that 1 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, r� In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa t`fOs date: cy� s0�: 3/2/2016 J,AC' IOWA O. T.. ' 1,0 If�D. •. ""••S�= Office of Driver Services .i j � Iowa Department of Transportation _ Name: Nguyen, Son Minh DL/ID: 662YY1237 Feb,26. 2016 3:53PM Div of Criminal Investigation No -8602 P. 2 Frsrl:—h.y or ..—. "ny Cl.'. vruoo min men nrmi 02/26/2096 9611. 0490 r -.u02/002 STATE OF r O, Criminal History fy.I� f Record Request t rm To: IOWA Division of Criminal Investigation Support Operations Bureau, ill Floor 215 E. 7" Street Des Moines, Iowa 50319 (515)725-6066 (515) 725.6090 Fax A�ctX'�— of Birth Record I)CI Account Number: L1 on 2 (ifayplica6le) From: CI of Iowa city City CIcrIPs Office M.11 Washington Street loera Cify, 1A 52140 Phones 319-356-5041 Fax: 319-356-5497 L (/ g — ®--�( L �•6� I IdMsle ❑I cmale I� " v ^ � L� 4p waiPer mlorroaffon, Without a signed waiver Prom the subject of the request, a complete crimlual history record may not be releasabio, per Code oflowa, Chapter 692.2. Por comatete criminal history record informatioh, as allowed bylaw, always obtaht a waiver si¢aature from thesubiect of the renueet. Waiver Release:1 hereby give permissinn for the above requesting ooiciat m eondua M Initu aiminal hill ory record chrek wid; the rlivisimi of criminal Invesligalion (DCI), Any criminal history dalo caloeming me thal is maintoined by the DC(maybe released as anowed by law, WaiverSignafnre: IOU Criminal history Record Check Results As of a search of the provided name and date of birth revea, :; .t Na Iowa Criminal History Record found with DCI ® Iowa Critninal History Record attached, DCI DCI initials DCI -77 (08/25110) Received Time Feb.25. 2016 2:04PM No -0266