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Home My WebLink About17-0621 � I CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)356-5040 (319)356-5497 FAX 1. Name (REQUIRED) . 2. Address (REQUIRED) IDENTIFICATION NO. 1'1--bI-27 — (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 I Middle Last --- 3. Contact Information (REQUIRED) Email: 6\LI(,e,MCell Phone:,S(� - �JO - bu &5l (All written communicate s nt via email) 4a. Driver's License expiration date (REQUIRED) _Q 6 --s—In I - 2,k3 b. Taxicab Business Name (REQUIRED) ' c\ Tem 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? KM 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 pffenses in the last five years? 1 Z SPl t? S 2 I S N of So kn5tl /r Type ofoffense ib �J/ P 1 S\ Where 2��!-et° henot'WsdH L ;113 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? h n Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please 1 -- oIle DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STAWC ERTfTIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE biAF REVIE� w You must apply for an individual Department of Criminal Investigation Report (form available ulo request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 1 Twn k issued on o`5 -a - I S expiring on ego- CI - Zo I g I understand that if I falsely answer any q tions 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 �!vr ^� i Date �O ,f - (q - N1YYlHlNYNY'YfYYkfYYl.fflHlf HfHH1HH11flflMflflYfINNNYNYYYYYrfflfHff11N1N1N1fH1H111fff11N1fifYiiitHlHlllfINNNNNY'YYRNY STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this k 9� day of clic in and foMhe State of Iowa .f4tklaMfHa 6* 4 6 6hH4i14yffiNl�fliilflMtMlNfHlrlRl,Iikl4fR}N1efNNNfN4YYftkf�ffNtRyfHHi-iYi 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 /701 � r 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. Approved application DCI report State certified driving record Website update -v o � a � =' w 0 CIeWTAXIDRNBADGEAPPL92014 mane DOC 0712016 4\1 `- re off CClerk or designee Date Lif=!ff i..Y.YiYIH, *fY•NYfiY,.iNii.HYiiiNNNN,H.1Hf HHNflNIN,NNNiYHH.iiHYNNYN..H.111.!.1.lflfHlfl�.....i...«..Hfiff..if Office Use Only o c.-) -ao C-)-< V r Approved application DCI report State certified driving record Website update -v o � a � =' w 0 CIeWTAXIDRNBADGEAPPL92014 mane DOC 0712016 ^- Iowa Department of Transportation pp Office d Dnver Servxm (Toll Free) 800-532.1121 Fro Div 9204, Des IAOMim, IA 503069204 515-244-9124 FAX 515.239-1837 Certified Abstract of Driving Record Inquiry Date: 4/24/2017 DL/ID #: 433ZZ6758(IA) Customer #: 1542644 Name: Tmong, Tnnh Cam Class: D ID Status: None Address: 1404 PRAIRIE DU Audit #: 6973210 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: 05/23/2013 Expiration Date: 06/01/2018 Endorsements: 3 Restrictions: NONE Date of Birth: 6/1/1970 Sex: F History Information CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County 3UR 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 S92 Seed Johnson 18 0 01/2017 0 0 2017 S92 S eed Johnson IA Name: Tmong, Trinh Cam DL/ID: 433ZZ6758 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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 [&a Department of Transportation to so certify. > 70 t i In witness whereof, I have caused my signature and the seal of the Department to be set upon this d6afflent, Y-Anke fy r,wa this date: err— -0 i7 � .. G.1 From:Ctty of Iowa City Clark Office 319 3666497 03/28/2017 17:05 STATE ATE df F IOWA Criminal History Record Check Request Form 4889 P.002/003 DCI Account Number:—}— (if applicable) To: Iowa Division of Criminal Investigation From: City of Iowa City Support Operations Bureau, I" Floor City Clerk's Office 2I5 E. 7" Street 410 E. Washington Street _ Des Moines, Iowa 50319 (515) 72!t-6066 luvr 2240 (515) 725-6090 Fax Phone: 319-356-5041 Fax: 319-356-5497 I am reauestine an Iowa Criminal History Record Check on: Last Name (mandatory) First Name (mandatory) Middle Name (recommended) (DC�unty) 3 �t`t� n4 As of a search of the date birth >o t —If wo provided name and of revealia: Date of Birth (mandatory) Gender (mandatory) Social Securi Number (recommended) []Male ®Female h Waiver Information: Without a signed waiver from the subject of the request, a complete criminal history record may not C) Waiver ReieaSe: I hereby give permission for the above requesting official to conduct an Iowa criminal history record check with the Division of Criminal Investigation (DC7). Any criminal history data concerning me that is maintained by the DCI may be released as allowed by law. Waiver Signature: - 1Sat� v I wa Criminal History Record Check Results, — (DC�unty) 3 �t`t� n4 As of a search of the date birth >o t _. r provided name and of revealia: rn No Iowa Criminal History Record found with UCI C) a ca ❑ Iowa Criminal History Record attached, DCI # DCI initials Lit -I-/ / (ad/LJ/(ll) :;3, Received Time Mar, 28. 2017 4:43PM No.6209