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Home My WebLink About20-047r IDENTIFICATION NO. 20 - 0 `i -� (Office Use Only) ._ 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 Failure to complete the "required" information will result in denial of the application Iowa City. Iowa 52240-1826 (319) 356-5040 Last First (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) IL -OL 1 3. Contact Information (REQUIRED) Email: \ 1 4a. Driver's License expiration date (REQL b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: communication Middle ;ell Phone: _&q- - 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? N Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Nb 7. Have you been arrested/ charged with any traffic offenses in the last five years? V6 Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other�a 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) 1A0 (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) .Zfr:ISi [c] le Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER 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 issued to me by the Iowa Department of Transportation a valid Driver's license number 4 �� Z� )�:'15R issued on k),_-Mxpiring on 06_ �l - �X C� 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 gym_ Date _q - g - Hrrrrarr+++++r+rrrrrrr»rrrrerrr::rr::mr+rrrrrrr++sr++`r>:rrrr:rrrrr:rrrrrrrrt+rawrr»rrr:r»rerrrrr»rr>rrrrrrrrrrrr�r:rrrrrrm+rrrrmr+: STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this day of Notary Public in and for the State of_I0 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 Si nat Ice 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 Approved application DCI report State certified driving record Website update aeM1JTA%IDRNfl4DCEAPPI.9I018amendatl DDC Office Use Only �ol2J,1'2_0 Date 04/2018 C AO10WA00T www.iowadotgov SMARTER I SIMPLER I CUSTOMER DRIVER Drwwr & IaatWBeawn sarvilm PO fiat 92011 Des Moines. IA 5QlO& M Phone 515-24491241 Fax 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 10/12/2020 DL/ID #: 433ZZ6758(IA) Customer #: 1542644 Name: Tmong, Trinh Cam Class: D ID Status: None Address: 1404 PRAIRIE DU Audit #: 4282777 DL Status: VAL CHIEN RD City/State: IOWA CITY, IA 522455614 Mailing Address: 1404 PRAIRIE DU CHIEN RD Mailing City/State: Convictions IOWA CITY, IA 522455614 Issue Date: 10/26/2019 CDL Status: None Expiration Date: 06/01/2026 CDL Cert Status: None _=' Endorsements: Chauffeur 3 CDL Med Status: None:; Restrictions: NONE Restriction. -None- Johnson IA Supplement: Date of Birth: 06/01/1970 --' Sex: F - - History Information Citation Date Conviction Date ACD Explanation County JUR 02/01/2017 02/02/2017 S92 Seed Johnson IA 11/10/2019 11/14/2019 M14 Fail to Obey Traffic Sign/Signal Johnson IA 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: Name: Truong, Trinh Cam DL/ID: 433ZZ6758 10/12/2020 C� Driver & Identification Services Iowa Department of Transporation - Fro Oct, 5. 2020„ 2: 53PMC1.1k DCI IOWA 319 3566497 10 V. ,0,01/2020 09:6rN0. 7927127P. 1/2'002 STATE OF IOWAsyr Criminal History . . co�d Check Request Form �� 1 To: Iowa Division of Criminal investigation Support Operations Bureau, I" Floor 215 E. 7" Street Da Moines, Iowa 50329 (515) 725-6066 (515)725.6030 Fox I am reauestino sun Inww criminal Niernr 120rnr.i rl%. I, DCT Account Number: lyDOZ - F (if applieable) From: Ci of Iowa City City Clerk's Office 410 E. Washington Street Iowa City, IA $2240 Phone: 319-356-5041 Fas: 319-356-5497 - Last Name (mandatory) First Name (mandato Middle Name (recommended) Date of Birth (mmaetory) Gender (mandatory) Social Security Number rcconmxaaea) 0Male ]Female g _ 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 conics criminal history record information, as allowed by law, always obtain a waiver signature from the subject of the request. Waber neievtse: I hereby aivc pemtission far the above requesting o6ual to wndua a, lows, criminal history reeord clerk with the Division of Crisahaal tnvestigation (DCO, My criminal history data conceraingng a .inleo! .inW by the DO may be released as allowed by law. Waiver Signature: Iowa Criminal History Record Check Results As of (QO: a search of the provided name and (y: ),..........fib W .'. G No Iowa Criminal History Record fomld with DCI; A:S; 'a: Iowa criminal 13 Iowa Criminal history Record attached, DC! #_ a history results. DC! initials `%, sr •...... S9; Cminatio" N"`0 Y1/•1 nv rn n m r .. n. lllllalmlall --...--- - -- Received Time Oct. 1. 2020 9:25AM No.7496 Q Z_ cc 0 ;.2(2?n V DC: '.w1R No. 7927 P. 2/2 DISCLAIMER This response can only Include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidential juvenile court records, if any, cannot be included in this response. A signed release authorization is not sufficient to obtain this information from the Division of Criminal Investigation. In order to request the release of confidential juvenile records, if any, an application most be filed pursuant to Iowa Code section 232.147(18). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry. http://www,lowasexoffender.com/. However, even though some information is available on this site, the actual records forjuveniles may still be confidential and any confidential juvenile records cannot be provided with this record. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(16). ti N 0 O n N M -0 r� 9 _Crn