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Home My WebLink About17-061CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52 240-1 82 6 (319)356-5040 (319)356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. l 7 � l (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) via email) 4a. Driver's License expiration date (REQUIRED) ,I Zj — Z D t 1 b. Taxicab Business Name (REQUIRED) ��' G l t 5. Prior experience in transportation of passengers: 7- 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five year v rsr v �/ � Type of offense G/t zp t ( 1 pup -peer N "6 h t n4 SO k y* A aloN�W�ela'f�C �) Aal When (,-A.-12 C .1- I 2�2tl— W hat 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? //P Type of offense Where 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please When N DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STAT' TIMID t , f DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE I& or REVIEW ca You must apply for an individual Department of Criminal Investigation Report (form available up6ry request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 �' APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby rt� at I gave issued to me by the Iowa Department of Transportation a valid Djiver's license number x,A i P_ issued on 10 &piring on r - LI 20 ! �. 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/,� v I, A Date �1 -7 MMMf'Fi,11f 11fH1fH4HH1fH4HHHYHHMHlH1ffllfiM4H1H11HHHHHHHMIIMlMIMIMIfIHf flHflfHY4f 111M1fYf1HH11MMff41f4fH4 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this `cam" day of clic in and for the State of Iowa ..MMM....M&4& *...f..f.M,HM......,,,,HH....M.......HMffM..............M..� 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 Driver's license I /Y f ()t Signature of Police 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. Sigmatuabof City Clerk or designee Date DCI report State certified driving record Website update -�"m <� -o A Q O� 0 CI.WYMIDRNRADGEAPPL92014amended.DOC 07/2016 4f,Yf4„lM.MMMM,1fl1111MlMYM1f,f f,..Mf,f H„fff1HH,,,.,MM,,,lf,,,MMM,f,1f,Mf,MHHMHHHH.....fffM....HMHHHHY,H,.., N O Office Use Only CD y —� za: c") .9 D=r � Approved application n� DCI report State certified driving record Website update -�"m <� -o A Q O� 0 CI.WYMIDRNRADGEAPPL92014amended.DOC 07/2016 CIowa Department of Transportation AO Office d Dnvet Senowm (Toil Free) 800-5U-1121 PO Box 9204, Des Manes. IA 503D6-9204 515-244-9124 FAX 515.239-1837 Certified Abstract of Driving Record Inquiry Date: 4/24/2017 DL/ID #: 769YY9401(IA) Customer #: 2348748 Name: Tlet, David Cuong Class: D ID Status: None Address: 1404 PRAIRIE DU Audit #: 7577206 DL Status: VAL CHIEN RD City/State: IOWA CITY, IA 522455614 Mailing Address: 1404 PRAIRIE DU CHIEN RD Mailing City/State: Convictions IOWA CITY, IA 522455614 Issue Date: 12/03/2013 Expiration Date: 01/04/2019 Endorsements: 3L Restrictions: NONE Date of Birth: 1/4/1970 Sex: M History Information CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County JUR 06/08/2013 06/13/2013 592 Speed Johnson IA 02/12/2014 02/24/2014 M14 Fail to Obey Traffic Sign/Signal Johnson IA 02/14/2014 0 24 2014 N82 Improper Backing Johnson IA 03/08/2014 06/12/2014 M14 Fail to Obey Traffic Sign/Signal Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Cam Number JUR 112/14/2013 773213 1 IA N O J Name: Tiet, David Cuong DL/ID: 769YY9401 OC') --a—n_ 7} t V0 r C? X t Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Departmerht$Pfanspo do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is a"DlaccM§te corn" an official record currently in the custody of said Office, and that I have been authorized by the Director of�Mwa-Mpartment of Transportation to so certify. C? In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa 1-rOm:Clty of Iowa City Clark Offica 319 3565497 03/26/2017 17:06 31889 P.003/003 STATE OF IOWA <r i Criminal History Record Check Request Form DCI Account Number: _ 4(30 % — F (1fapplicable) To: Iowa Division of Criminal investigation From: City of Iowa City _ Support Operations Bureau, I" Floor City Clerk's Office 275 E. 71h Street 410 E. Washington Street Des Moines, Iowa $0319 - ----- - (515)725-6080 Fax ' Phone: 319-356-504I Fax: 319-356-5497 I am re0uestinv an Tnwa Cr;m;nal A;e....., vo,-,..a ok—i.— Last Mame (mandatory) First Name (mandatory) Middle Name (recommended) h Date of Birth (mandatory) Gender mandatory) Social Securityumber (recommended) 11 —� 6 Male ❑Female Z� Z _ — Waiver Information: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed by law, always obtain a waiver signature from the subject of the re nest. WaiVer ReleaSe: l hereby give permission for the above requesting official to conduct an Iowa criminal history record check with the Division of Criminal Investigation (DCI). Any criminal history data concerning me that is maintained by the DCI may be released as allowed by law. Waiver Signature: Iowa Criminal History Record Check Results o cDC,weonly) O —a As of �3 a search of the provided name and date of birth reveta$!�- , 30. an Cl) No Iowa Criminal History Record found with DCI -4 rn ❑ Iowa Criminal History Record attached, DCI # -o DC1 initialsJ Received Time Mar. 28. 2017 4:43PM No, 6209