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Home My WebLink About18-056 IDENTIFICATION NO. / 7 —Q S _ 1 (Office Use Only) imegincir. 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) "C,nrh Qacn 't C1q 2. Address (REQUIRED) l�\O- Qcac e C•13 C. item c2 ,, "IQ�a C 1 L, A 51,1 J 3. Contact Information (REQUIRED) Email: hoelcurst l_ekmo ..eor2 Cell Phone: (, \A)33p-touk35 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED 1 4310/O 11.0 b. Taxicab Business Name(REQUIRED) 9v)-rtr c Cab *c--) C --n 5. Prior experience in transportation of passengers: cwt 'c c 7>a7-A rn 6. Have you ever been arrested /charged with any misdemeanors and/or felonies in this Stator elsewhere?"'$\0 Type of offense Where W hen.D 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? t lS Type of offense Where When NeeCk 4 .ia, l 1 f ci/1.0k3 e•-..7Z\ 7Z L\k�1C�C,1 mfl ‘01u'i/2.014 Wha happened to the charge?(Circle one) 3O`'>C1z4ZIO uVoV7-oc' (Convicte 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? tv) 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) 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 t %37,3.0 6% issued on oodinflon expiring on /ov/20a . 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, 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 proy iions of Ti 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) 19M71 Signature of Applicant > Date L - 1 l/ " STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by _C C,Tr. v o►•, c1 on this day of a o 17,g ! blic in and for the Stateof Iowa •'I3��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 Driver's license Q( .v/$ .. " I' ' oco t oS- /7 -2-47g< i Signature of lice Chief or esignej ��,�'� D AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAE liVtFOWfrCIrgeR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Signatrrrfe of City Clerk or ignee to ***.** **.******************************* Office Use Only Approved application DCI report State certified driving record Website update CIerWTAXIDRIVBADCEAPPL92014amended.DOC 07/2016 FrNay._ j, MO 12: J/1911ctOrUiv OT Criminal investigation No, 05]3 P. 19/19 ._ _ — , —...-- —•— ---- 06/01/2018 17:C.. 1 ' :I !,, • as ,,:r STATE tqyyn�-�� ,, 1. ,.,,V J•,,,,.. STATE OF IOWA ��q/y�.ltl �.� 1/\,50.-,,,-,:1114 0.- -tet,, d .5:.::1: i � •�: Lam/ ��71�4 �,�`.'.''•:�9� F iewa� Criminal History Record Check _4 > . DCI Account Number: (-)p c (If applicable) To: Iowa Division of Criminal Tnvestigatlon From: City of Iowa City Support Operations Bureau; 1"Floor City Clerk's Office 215 R.7'"Street 410 L.Washington Street Des Moines,Iowa 50319 (515)725-6066 Iowa City, TA 52240 (515) 725-6050 Fax Phone: 319-356-504) Fax: 319-356-5497 — I am requesting an Iowa Criminal History Record Check on: Last Name (mandatory) First Name(mandatory) Middle Name(reeoa>mended) `�t�n5 • -Tc\Vh Carr, Dstte of Birth (rnandaiory) Gender(mandatory) Social Securi Number(recommended) °b/ot/ R10 l..\ 5 - z5- 5660 ❑Male ElFetnale r mmimmiliMW AMY •1 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 request. Waiver Release.1 hereby give permission for the above rcgoesting official to conduct an Jowa criminal history record check with the Division of Criminal 1nvcstligation(DCI). Any criminal history data concerning me that is maintained by the DCI may be released as allowed by law. Waiver Sign attire: •, ,– W a tv Iowa uriminal >story Record-(.heck Results - --- (nee only) -- As of , ,y) , a search of the provided name and date of birth revealed: RI --it-) r oIowa Criminal History Record found with DC1 iti---/Cr- ::r 0 Iowa Criminal History Record attached, DCI# • DCI initials C C----' " 1)C1-77 (08/25110) Received Time May. 1. 2018 4: 25PM No, 8206 ir 111111 Iowa Department of Transportation CEP Office of Driver Services K Tdl F ree)£ 532 1121 PO Box 9204.Des Moines,IA 5030&9204 515-244 9124 FAX 515239 1837 Certified Abstract of Driving Record Inquiry Date: 4/24/2018 DL/ID#: 433ZZ6758(IA) Customer#: 1542644 Name: Truong,Trinh Cam Class: D ID Status: None Address: 1404 PRAIRIE DU Audit #: 6973210 DL Status: VAL CHIEN RD Issue Date: 05/23/2013 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 06/01/2018 CDL Cert Status: None 522455614 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 1404 PRAIRIE DU Restrictions: NONE Restriction None CHIEN RD Supplement: Date of Birth: 06/01/1970 Mailing IOWA CITY, IA Sex: F City/State: 522455614 History Information Convictions Citation Date Conviction Date ACD Explanation County _ JUR 11/09/2013 11/13/2013 S92 Speed Washington IA 10/05/2014 10/08/2014 S92 Speed Johnson IA 02/01/2017 02/02/2017 S92 Speed Johnson IA N O CD m C") C m Name:Truong,Trinh Cam DL/ID:433ZZ6758 CDJ'�C I Z �.... —�ef Pursuant to Iowa Code§321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Departtl,ept olefransprnon, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this kaiXve al/elaccu to opy of an official record currently in the custody of said Office, and that I have been authorized by the DiraZtto��r of t8Iowa Department W 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: irf 4, 4/24/2018 a: IOWA SS .sI * -117 e 4 6 e w P a ignature kt D. O. T � sanito.- Office of Driver Services t Iowa Department of Transporation