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Home My WebLink About16-0787r,rCi CITY OF IOWA CITY 410 East Washington Street Iowa Qty, Iowa 52240-1826 (319) 3S6-5040 (319) 356-5497 FAX IDENTIFICATION NO. //9— Cf--? R) (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 1. Name (REQUIRED) 2. Address (REQUIRED) L 3, Contact Information (REQUIRED) Email: commu 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) �� % 0 5. Prior experience in transportation of passengers: Middle ,, U ek-it A r- /4 tt email) 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? A/10 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? /VJ Type of offense Where When 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? Ald 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) , rd 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 Fage 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number rn d V U q issued on -0- xpiring on t / 1 understand that if I falsely answer y questions in this application, that this application may be denied. I agree th 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 infrontof a Notary Public) Signature of Applicant ��/� Date Ll LC STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by Day,' (J ( ) tt- on this I day of ATr. 1 7-0I t o 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 g I V,�- Signature o, lice 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. Signa nre of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update /�/� Date Clerks IDRIVBADGEAPPL92014ame,dedDOC 03/2015 Mar.•14 2016 2 : 0 5 P M Div of Criminal 1nve<tigation FrOnl:CIty of Iowa Clry Clerk 0Jrlce 319 aSSE407 Nio, 9580 P, 2/2 09/06/2016 17:40 #430 P•00s/003 nPtl 1p hu.,, STATE OF IOWA Criminal History Recil check Request h To: Iowa Division of Criminal Investigation Support Operations Bureau, V Fioor 215 C+, Jul Street Des Moines, Iowa 50319 (515) 725-6066 (51s)729-6000 Fax I Ain renueSflnH an Iowa Criminni IA istnly iienneri f Annie nn - DCI Aconunl Number: ftLoZ=p� (if oppllcnblc) From: _City of fovea Ciey City Clerle's Offal 410 7r, Washington kreet Cows City, CA 52240 Phone: 319-3S6-5041 rax: 319-356-5497 Last Name (mandamry) First Name mendarory) Middle Nainc (rc on,l» maedi I Date of 13irth (mamdalep9 Gender (malldatofy) Social Security Number (eeommeadedJ � jMaie ❑Female I L t r Waiver rnforntaflon,' Without a signed waiver from (hesublect of (he request, a complete criminal histury record may II01 be releasable, per Code of Iowu, Chapter 692.2. ,For comniete erli l history record Information, as allowed by law, always obtain a tvalver signature from the subject of the request. Waiver Releaae: I hereby give permission for the above requcliing offieiel to colder co Iowa criminal history record check with tike oivision of Criminal Im•esUgalion(Lil Any eril histury dale conccmil melhati maintained by W DCllnay he llis allon,ed by law. Waiver Signal 1 ' el Iowa Criminal HistoryRecord Check Results G (0cl ,nily) As of 13 It L( a search of the provided name and date of birth reveale'd`, r No Iowa Criminal History Record found with DCX _ -CI O U - 1 ® Iowa Criminal Hislory Record attached, DCI # DCl initials DCI -77 (08/25/10) Iowa Department of "transportation Ofte cK Unher Semces 11oft I Teo SW 532 1121 %&I PO Oak 920:4, UE -i Manes, 1A 5030(, 9204 515.244-8124 1 -AX 515 239 U31 Certified Abstract of Driving Record Inquiry Date: 2/11/2016 DL/ID #: 769YY9401(IA) Name: Tiet, David Cuong class: D Address: 1404 PRAIRIE DU Audit #: 7577206 Restriction CHIEN RD Supplement: under in 35-55 mph Issue Date: 12/03/2013 City/State: IOWA CITY, IA Expiration Date: 01/04/2019 07/31/2011 522455614 M14 Fall to Obey Traffic Johnson IA Endorsements: 3L Mailing Address: 1404 PRAIRIE DU Restrictions: NONE 12/28/2011 CHIEN RD M14 Fail to Obey Traffic Johnson IA Date of Birth: 1/4/1970 Mailing IOWA CITY, IA Sex: M City/State: 522455614 S92 Seed Johnson IA History Information 02/24/2014 Convictions Customer #: 2348748 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: under in 35-55 mph Citation Date Conviction Date ACD Explanation County JUR 02/24/2011 D2/25/2011 592 Speed (10 mph & Johnson IA under in 35-55 mph zone 07/31/2011 08/01/2011 M14 Fall to Obey Traffic Johnson IA Sign/Signal 12/28/2011 03/14/2012 M14 Fail to Obey Traffic Johnson IA Sign/Signal 06/08/2013 06/13/2013 S92 Seed Johnson IA 02/12/2014 02/24/2014 M14 Fail to Obey Traffic Johnson IA Sign/Signal 02/14/2014 02/24/2014 N82 Improper Backing Johnson IA 03/08/2014 06/12/2014 M14 Fail to Obey Traffic Johnson IA Sign/Signal Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 12/14/2013 773213 IA Name: Tiet, David Cuong DL/ID: 769YY9401