HomeMy WebLinkAbout19-034CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
Last
1. Name (REQUIRED)
2. Address (REQUIRED
IDENTIFICATION NO. _ li�-O YJ
(Office Use Only)
APPLICATION FOR TAXICAB l 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
First Middle
3. Contact Information (REQUIRED) Email: �)'A4e trxi%t,e`q'Ni,-', I Cell Phone:
(AII.Mtten communica wr�ent via email)
4a. Driver's License expiration date (REQUIRED) LI r 2 7
b. Taxicab Business Name (REQUIRED) rIQ �P h --�Gx', C a
5. Prior experience in transportation of
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Al iC
Type of offense
What happened to the charge? (Circle one)
Where
When
19 1019
City Clerk
Iowa City, Iowa
Convicted Dismissed Deferred Suspended Plead Guilty Other
7. Have you been arrested/ charged with any traffic offenses in the last five years? /I/&
Type of offense
Where
When
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?
Tvce 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)
AND
04/2018
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
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).
I hereby certify that I have issyed to me by the IowaDepart ent of Transportation a valid Driver's license number
X61/ q 6/G 1 issued on 2 xpiring on ! ` Q –2o 7. understand that if
falsely answer any�stions in this application, that this ap lication may be denied. I agree that in ming 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 _,,ri {�I J Date
STATE OF IOWA )
COUNTY OF JOHNSON )
APR 19 2019
City, Iowa
Subscribed and sworn to before me by Z• v; .v C . \ on this `�day of
PAY tka��t�
in and for the
ac7
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 dat f nse
Signet 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.
—'
of City Clerk
Office Use Only
Approved application
DCI report
State certified driving record
Website update
CleM1✓rAXMWMDGEAP gnlBame CIOC
Date
04/2018
L,10WA00T
4/18/2019
DL/ID #:
�, ,A„A,,,,,.�C)WBfiCn
g
SMARTER I SIMPLER 1 CUSTOMER DRIVEN
2348748
Name:
D&W & 1aRlYleaBsll 3WVftas
Class:
PO Boa 8001 I Des hilaiRs. IA 5030680M
ID Status:
PhOW 315244-91241 Fall 315233163/
Certified Abstract of Driving Record
Inquiry Date:
4/18/2019
DL/ID #:
769YY9401(IA)
Customer #:
2348748
Name:
Tiet, David Cuong
Class:
D
ID Status:
None
Address:
1404 PRAIRIE DU
Audit #:
3583610
DL Status:
VAL
03/08/2014
CHIEN RD
M14
Fall to Obey Traffic
Sign/Signal
Johnson
IA
Issue Date:
02/02/2019
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration Date:
01/04/2027
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
02/12/2014
02/24/2014
M14
Fail to Obey Traffic
Sign/Signal
Johnson
IA
02/14/2014
02/24/2014
N82
Improper Backin
Johnson
IA
03/08/2014
06/12/2014
M14
Fall to Obey Traffic
Sign/Signal
Johnson
IA
Name: Tiet, David Cuong DL/ID: 769YY9401
Pursuant to Iowa Code 4321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Department of Transportation,
do hereby certify that I am the custodian of the records held by Driver & Identification 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:
Name: Tiet, David Cuong DL/ID: 769YY9401
4/18/2019
A2-,
Driver & Identification Services
Iowa Department of Transporation
Mar.28.2019 4:01PM DCI IOWA
Feoell:Clty of Iowa Clty Clark Offloo 313 3666687
No.2348 P. 1/3
03/22/2019 12:211 Me66 P.002/003
STATE OF IOWA
Criminal History Record Check
Request Porn'
To: Iowa Division of Criminal Investigation
Support Operations Bureau, I" Floor
215 E. 7a Strcet
Des Moines, Iowa 50319
(515) 725-6066
(515) 725-6080 Fax
I am reauestine an Iowa Criminal History Record Check nn -
DCI Account Number:
pr applicable)
From: City of Iowa City
City Cleric's Office
410 E, Washington Street
Iowa City, IA 52240
Phone: 319-356-5041
Fax: 319-356-5497
Last Name mandatory)
First Name (mandmory)
Middle Name (recommended)
V
Date of Birth (menecato y)
Gender (mandatory)
Social Securl N er (mcammeaded)
[ Male ❑Female
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 bylaw, always
obtain a waiver signature from the subject of the request
Waiver Release: l hereby give permission for the above rcqucsting official to conduct an Iowa criminal hislory«word check wish the Division of Criminal
Invesligalion (DCI). Any niminal hismry dale eoneendne me alai is maintained by the DCl may be released as allowed by law.
Waiver Signature: S�
F
Iowa Criminal History Record Check Results
As of _ '3— a - `�a search of the provided name and date of birth revealed:
§LXO lova Criminal History Record found with DCI
❑ Iowa Criminal History Record attached, DCI #.
DCI initials
DCI -77 (08/25/10)
D . . . :.,-1 T,_. Il.. nn nAIn 1n, 10 DIA kl, 11AI
(DCt use only)
A,: ';t: f1WA/DPS
MAR 2 2 2019
OF CRIMINAL INVEST