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Home My WebLink About14-072 r Authorization Number r (Office Use Only) Angela 11Z..=gx.31 oln W; 4:21irikal ,ti "4 MO 1141:171r APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington Street between 8 a.m. to 3 p.m., Monday—Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name 1\t \ 2. Mailing Address I L-W.)t'{ CICTS:c:e 100 CRe d C )c'3 C .LA 3. Telephone: Home 3 4 ^3 3e—G4--) .3 Other: 4. Prior experience in transportation of passengers:`I Po SS e h A yc 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? !J p Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? MCS Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When opted M,.) CD/ a /12 f\ ,_c-)hcsco� i2/1-I/12 S e waw\-\meq ton " ��1_3 i3 8. Has our river's license or chauffeur's license been suspended or revoked in the last five years? J O 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) 1VC� 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerkrtaxidrivbadg 03/2013 I herby certify that I; have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number i-1 6 Z ( )' `7 . I understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application wiN 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 a license 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 'c:71\,1,11-1 ILL' Date L "If f - 1 ........................................................................................................................... STATE OF IOWA ) COUNTY OF JOHNSON ) SubscribedC "syy orn to before me by 1 r i rk1"l f (' //f O n 0� . On this -) 44`�' `� day of I o ,i l,, I KELLIE K.TUTTLE ��.e_ L �t )4. < /i.t l 1 R ,. Commissioq Number 221819 NotaryPublic in and for the State of Iowa jt my._ .Y iom/ni�io )Expires I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). 14......._________----- designee 3 /2S /y Signature of Police Chief or Date 9 YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. 2.-erg.1-e-2 e• . -..-••___.-2:_z...,-, _s/,i ,i- ./ Sign Lure of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width)and 5 '/2" (height)and prominently displayed to all passengers. ................................................................................................................................................ Office Use Only Approved application DCI report State certified driving record Website update clerk/taxidrivbadgeapp2010.doc 03/2013 C83 Iowa Department of Transportation pp Office d Driver Scrnces (roil Free)000-532-1121 PO Box 9204,Des Moines,LA 50306-9204 515-244.9124 FAX:515-239-1E137 Certified Abstract of Driving Record Inquiry Date: 3/16/2014 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: 3 CDL Med Status: None Mailing Address: 1404 PRAIRIE DU Restrictions: NONE Restriction None CHIEN RD Supplement: Date of Birth: 6/1/1970 Mailing IOWA CITY,IA Sex: F City/State: 522455614 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 05/26/2012 06/04/2012 592 Speed (10 mph & Muscatine IA under in 35-55 mph zone) 12/04/2012 ,12/11/2012 S92 Speed Johnson IA 11/09/2013 11/13/2013 592 Speed Washington IA Name:Truong,Trinh Cam DL/ID:433ZZ6758 Pursuant to Iowa Code §321.10, I, Kim Snook, 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: .SWWif'"ghr 3/16/2014 141: IOWA/`=4, N,ci: , -`s iMh � _oer Office of Driver Services Iowa Department of Transporation Name:Truong,Trinh Cam DL/ID:433ZZ6758 MurI: 12. 2014 1 : 04PM turf .1 I 0 VI III tDivrof Craimioal rInvestvt �iaaatio NNo.T1765 PP. L1.2 • r � STATE OF IOWA t�t�u C`A'S � Criminal History Reco).d Check �r. ' =ti (,mwe' 1 ' � ` �� l -��-,...11"-:t. RequestForm \`�I:• r, DCI AccountNamber: ync, -P (if applleabie) To: Iowa Division of Criminal Investigation Prom: City of Iowa City Support Operations Bureau,l'i Floor Clty Clerk's Office 215 P.In'Street 410 Tv,Washington Street Des Moines,Town 50319 (515)T25-6066 Iowa City, TA 52240 (515)725-6050 Fax Phone: 319456.5041 Fax: 319-356-5497 I am requesting an Iowa Criminal IIisto Record Check on: Last Name (mandetory) [First Name(mendolor ) Middle Name(recommended) Date of Birth (mandatory) Gender(mandatory) ' Social Security Number(recommended) ND'_0`_ ,p"° • DMate '®Female q gc - Z S - c 6 a o 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:l hereby give permission for the above revealing official to conduct an Iowa criminal hlstory record cheek with the Division of Criminal Investigation(DCO. Anyalminal history dotccaanting me that is maintained by the DCI may be released as allowed by law.traI WaiverSigIIafare; V VrJ'n � bs - w Iowa Criminal Histor Record Check Results (DClusb only) re) As of 312-i y , a search of the provided name and date of birth revealed: C i..,u -o _0 •iFr.l laL No Iowa Criminal History Record found with DCI f.,7:=" — "Ti CS " r c ® Iowa Criminal Moiety Record attached,DCI# ''rte--- DCI initials ibw Received Time—Mar. 10, •1014— 4: 59PM—No. 4804 hnr en /MOI1CII a\