The URL can be used to link to this page

Home My WebLink About18-046 IDENTIFICATION NO. ( (� _0 4/h _ 1 (Office Use Only) �1 III vs 0.1111111117 APPLICATION FOR TAXICAB/ MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday- Friday) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name (REQUIRED) Dag td C)Q -Viet 2. Address(REQUIRED) (HOS PC'a c\t C1KCN- c d ,�A� 1-LA 51:TA6 3. Contact Information (REQUIRED) Email: dZNAitt -"n uprfA• uxn Cell Phone: (3'4)**1 -MS (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) Q /Qty/la,O�q b. Taxicab Business Name (REQUIRED) ,a',3 _HCl -Cay\ („vp 5. Prior experience in transportation of passengers: may, C)tcwt c cc n k 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? ryp 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? =' � Type of offense Where I4a�n i1 °cLN\-73 ,ark‘oyis\ koct,cco oti-4M4 What happened to the charge? (Circle one) Q vciConvicted Dismissed Deferred Suspended Plead Guilty Other ty ry, 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? CID 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) C\0 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) 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 —1.0gyyqi-kpl issued on 1?,/03/xot9 expiring on WOH/2Ot0j . 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 ' Ct14 , Date L( - 2 1 I—201 *****************!**************Yr****************************** *****************************AAAA* AAAA****k*******A A A A A f***************** STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribec and sworn to before me by `D a.v T i on this 2-%-) day of ,11 -, 7012) . WENDY S MAYER Notary Public in d for fFie State of a R Commission Number 729428 My mm Pim ***** *********************************AAAA*************************** 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 :��'.'immense 0'1—ON-/9 Signa 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. co Si. ature of ity Cler i es r designee Dat -:-i* = .�.. ?--, r < m ***************************.****************************************** **********AAAA *** ****, ..******** Office Use Only iy ry cn Approved application DCI report State certified driving record _ Website update perklTNGDRNBADGEAPPL92014amended.DOC 07/2016 'rig I. L/. cir i V 1V•[]nni V I V 0I cr Iminai investigation No. /119 P. 1/3 From:Cl ty Of low. City Clerk CS if toe 316 35 E487 03/23/2018 0e 3 bads P.003/003 • I . • 'sir ri„ -STATE OF IOWA rp c'; ,town 1' Criminal History Record Check iii .5\40..-7„..„4,i Request Form ,.:..r.. .jyl,..,.c + r - DCI Account Number: ii`QQ0-- R (if applicable) To; Iowa Division of Criminal Investigation From; City of Iowa City Support Operations Bureau, 14 Floor City Clerk's Office 215 E,7'"Street 4101. Washington Street Des Moines,Iowa 50319 (515)725-6066 Iowa City, IA 52240 (515)725-6060 Fax Phone; 319-356-5041_ Fax: 319-356-5497 I am requesting an Iowa Criminal History Record Check on: Last Name (mandato) mm First Name(mandatory) Middle Name(recoended) J ,t ' - Date of Birth(mandatory) Gender(mandatory) Social Security Number(recommended) 0 iL; . 7 U PMale OFemale _21,1._.61 L 6 L ero uiver i'I Juwmarron; Without a signed waiver from the subject of the request,I 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 request, ti Waiver Release:t hereby give pemtlssion for the above requesting official to conduct en Iowa criminal history record the*aifh:the D...,on daily y Invesligaiion(ACO. Any criminal history dela concerning me that is ainlaincd by •e DCI may be released es allowed by law, y_' f� i / C)--C N.) Waiver Signature; ;t.r/C' �...c La•:� _• - 0 Iowa Criminal History Record Check Results =-:-' c..0 1�ZUCtuseonly) As of , a search of the provided name and date of birth revealed: t , Na Iowa Criminal History Record found with DCI ,. • 0 Iowa Criminal History Record attac ed, DCI# . DCI initials • • DCI-77 (08/25110) Iowa Department of Transportation Once of Omer : rviccs (Toll Flee)800 532 1121 U l c) Ho. '_+2114 (�r-s Mirnc., IA `. 'q), `_+2)4 315-244.9124 IIIIP FAX:515239.1837 Certified Abstract of Driving Record Inquiry Date: 4/24/2018 DL/ID #: 769YY9401 (IA) Customer#: 2348748 Name: Tiet, David Cuong Class: D ID Status: None Address: 1404 PRAIRIE DU Audit#: 7577206 DL Status: VAL CHIEN RD Issue Date: 12/03/2013 CDL Status: None City/State: IOWA CITY,IA Expiration Date: 01/04/2019 CDL Cert Status: None 522455614 Endorsements: Chauffeur 3, CDL Med Status: None Motorcycle Mailing Address: 1404 PRAIRIE DU Restrictions: NONE Restriction None CHIEN RD Supplement: Date of Birth: 01/04/1970 Mailing IOWA CITY,IA Sex: M City/State: 522455614 History Information Convictions 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 Johnson IA N Sign/Signal o O m 02/14/2014 02/24/2014 N82 Improper Backing Johnson 21" •1 L v � { 03/08/2014 06/12/2014 M14 Fail to Obey Traffic Johnson >"171, ...� Sign/Signal -< N r- - -4 C") ¢' -<I _ rn Accidents - Accident involvement indicated does NOT mean the indivial aas afj fault or given a citation. -� ' ry Accident Date Case Number JUR - 112/14/2013 773213 IA Name:Tiet, David Cuong DL/ID:769YY9401 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 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: N, 4/24/2018 IOWA ::�, _€6466.41)3 -[cfi: V� D. 0. T. h,f 8RI ' — Office of Driver Services Iowa Department of Transporation Name:Tiet, David Cuong DL/ID: 769YY9401