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Home My WebLink About16-077CITY OF IOWA CITY 410 East Washington Strccl Iowa City, towa 52240- 1826 (319(356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) - 2. Address (REQUIRED) IDENTIFICATION NO. J (9 . 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 Middle C -A K4Last 3 3. Contact Information (REQUIRED) Email ; i nc� J` q fll Phone: 3)q- (All written communication sent vFA µemail) 4a. Chauffeur's License expiration date (REQUIRED) QD G 0 ) - -9 U ) n b. Taxicab Business Name (REQUIRED) 5, Prior experience in transportation of passengers: 6, Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? A/% Type of offense What happened to the charge? (Circle one) Where Convicted Dismissed Deferred Suspended Plead Guilty 7. Have you been arrested / charged with any traffic offenses in the last five years? Vo Type of offense What happened to the charge? (Circle one) Where When Other When 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? 00 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 h�er�;b %certify/l hat I ve issued to me by the Iowa Department of Transportation a valid Chauffeur's license number Jd_J_L77 C_� Issued on N ,I-�N1 f2 PYnirinn nn (�r /^I I q,, Id I ,k_, :s , falsely answer any questions in this application, that this application may 6e denied.I agree tha'--t 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 VW41 Date STATE OF IOWA ) COUNTY OF JOHNSON Sues filled and sworn to before me by C f, v\ )n C Ci 4 �,w,z on this �_ day of for the State of 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 Chauffeur's license I1111112,01 0 g --- Signature y Chief or designee ZZ2J Date AFTERAPPROVAL 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. �/,/. e� ,< �) Signature of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update clerkrrAXIDRNeADGEAPPL92014a,.nded Doc 0312015 Mar. 14, 2616 2:05PM Div of Criminal Investigation No. 9580 P. 1/2 Fr*m:Cley Of low/ Cley Clerk 0MO& (al- 06e649� 03/09/2096 'Y:39 44so P.002/003 STATE I I I IOWA [[ aI Criminal Ristory Record ChedlIt .:r• rtt> t.Request Form �f/•,�•'Eunllr. To; Iowa Division of Criminal Investigation Support Operations Bureau, PI Floor 215 E. I" Street Des Moines, Iowa 50319 (515)725-6066 (515)725-6000 Fax I am reauestinu an Iowa Criminal l4istory Record Cheek mi: DCI Account Number _ � b p (I t appli,Flble) Frons City of Iowa City City Clerit's Office 4lo C. Washlttglon Street Iowa City, IA 52240 Phone; 319-3$6-5041 Fare, 319-3565497 Last Name (,nndatory) First Nalne (mandatory) Middle Name (rewnmfcnded) ))ate of Birth (rnandatory) Gender (mandatory) Social Security Number (recmnmcndtd) ❑male QSTemale Waiver InforNtatiolr: Without a signed tvaiver from the subject of the request, a complete criminal history record may nol be releasable, per Code of Iowa, Chapter 692.2. For camolete criminal history record Information, as allowed bylaw, always obtain a waiver signature from the subject of the renuest. Waiver Release: i hereby give penuission for the above regvcsting en{tial to condaet an Iowa criminal history record check wiul The bivisian ofCrimmol lilvaaligadan (DCI). Any criminal history dale eoncrming nm Ibat is maintained by the DCI may be Ieltsze. l as allowed by law, Waiver Sipiafure; .av .. .. vueaa�r+.a aaaawa ati�a.viu tiiaAv�-+til\GnuaW_ (DCi life only) As of 3 I LI 1.6 a search of the provided naive and date of birth revlraled: c.,,; No Iowa Criminal His(ory Record found with DCI �� ) a Iowa Crinninal history Record attached. DCI # f DO initialsW _ DCI -77 (08/25/10) CC Iowa Department of Transportation OMrx o1 Ofir r �S&wes 1loft ffeel f 1,32 1121 PO Sax 9204,t7cs f410{lle5, to 5t#3fid n 61'6 244 9124 FAK 6"21) 1931 Certified Abstract of Driving Record Inquiry Date: 2/11/2016 DL/ID #: 433ZZ6758(IA) Customer #: 1542644 Name: Truong, Trinh Cam Class: D ID Status: None Address: 1404 PRAIRIE DU Audit #: 6973210 DL Status: VAL 11/09/2013 CHIEN RD S92 Speed Washington IA 10/05/2014 10/08/2014 Issue Date: 05/23/2013 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 06/01/2018 CDL Cert Status: None 522455614 Endorsements: 3 CDL Med Status: None Mailing Address: 1404 PRAIRIE DU Restrictions: NONE Restriction None CHIEN RD Supplement: Date of Birth: 6/1/1970 Mailing IOWA CITY, IA Sex: F City/State: 522455614 History Information Convictions 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 IA 12/04 2012 12/11/2012 S92 Speed Johnson IA 11/09/2013 11/13/2013 S92 Speed Washington IA 10/05/2014 10/08/2014 592 Speed Johnson IA Name: Truong, Trinh Cam DL/ID: 433ZZ6758 Pursuant to Iowa Code §321.10, 1, 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: