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Home My WebLink About19-035CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-SO40 (319) 3S6-5497 FAX Last 1. Name (REQUIRED) I IDENTIFICATION NO. I 1- 0 3S-- (Office Sv(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 2. Address (REQUIRED) //, n/. 1 G" f; First Middle ellz 1 3. Contact Information (REQUIRED) Email 22 Ise Uo.C, Iq►,10 Cell Phone: 11 Lo -L4-Z6- (AII written communication se11t via email) 4a. Driver's License expiration date (REQt b. Taxicab Business Name (REQUIRED) 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? 06 Tvce of offense Where When Fil rn APR 19 1019 City Clerk Iowa City, Iowa 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? k' �:) Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Nn 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? Type of offense Where When F✓ 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 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 rtify t at I ve issued to me by the Iowa Department of Transportati n a valid Driver's license number ff 33 Z issued on C44L expiring on b. I understand that if I falsely answer any questions in this application, that this application may be denied. I agre 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 Not Public) Signature of ApplicantC�nl � A Date O j�i�L jj��'' APR 19 1019 City Clerk inwn citv,Iowa STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by r I (n c u O k1 on this day of Q r tory ublic in and for he'L� State of Iowa 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 o riv s i n e GN- Signatur f 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. Office Use Only Approved application DCI report State certified driving record Website update Ger*AMIDRNBADGEAPPL92018amended DOC 04/2018 CIOWA DOT ovt. SMARTER I SIMPLER I CUSTOMER DRIVEN www.;owadog DrNer & k%rffl taden Services PO Box 92M I Des Moines, IA 503D& M Phan 515-244-9124 1 Fax 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 4/18/2019 DL/ID #: 433726758 (IA) Customer #: 1542644 Name: Truong, Trinh Cam Class: D ID Status: None Address: 1404 PRAIRIE DU Audit #: 2809734 OL Status: VAL CHIEN RD Issue Dets: 05/15/2018 CDL Status: None CRy/State: IOWA CITY, IA Expiration Date: 06/01/2026 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 Name: Truong, Trinh Cam DL/ID: 433ZZ6758 Pursuant to Iowa Code §321.10, 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: 4/18/2019 A/12 Driver & Identification Services Iowa Department of Transporation Name: Twong, Trinh Cam DL/ID: 433ZZ6758 hr.28.2019 4:01PM DCI IOWA Prom:Clty of lown. City Clark Office 310 3666487 No.2348 P. 2/3 03/22/2016 12:30 #866 P.003/003 A STATE I�1 j �I ��,ul.'lo Criminal t a I t ,_ ; tForm' - To: Iowa Division of Criminal Investigation Support Operations Bureau, I' Floor 215 E. 7'h Street Des Moines, Iowa 50319 (515)725-6066 (515) 725-6060 Fax I am reouestinc an Towa Criminal Motnr i2 nrnrd (`t.o..l.....- DCI Account Number; 4rjo1—F (itapp11ca61c) From: City of Iowa City City Clerk's Office 410 E. Washington Street Iowa City, IA 52240 Phone: 319-356.5041 Fax: 319.356-5497 Last Name (manaaw First Name (mandatory) A7liddle Name (rewntmandcd) f taw f i rt h �L.2-I�t Date of Birth (mandatory) Gender (mandato) Social Security Number (mcemmeaded .. 0 1 ._- I q 0male ®Female , 0 5—, Q S- - t (� (—,:, C7 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 re nest, Waiver Release; I hereby give yomission for the above requesting official to conduct an Iowa criminal history record check with ala Division of Criminal Invesilgation (DCI), Any criminal history data cuncemingmc that is maintained by the DCI may be released m allmvad bylaw. Waiver Signature: _�1 A w �I, Iowa Criminal History Record Check Results As of a search of the provided name and date of birth revealed: *---XD Iowa Criminal history Record found with DCI El Iowa Criminal History Record attached, DCT # DCI initials ucl- i i (usage u) (DC) use only) OF IOWA/DPS MAR 2 2 2019 OF CRIMINAL I