HomeMy WebLinkAbout22-003 IDENTIFICATION NO. 22 Do ?
1 (Office Use Only)
41. III
APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m.to 3 p.m., Monday—Friday)
CITY OF IOWA CITY
410 East Washington Street Failure to complete the "required"information will result in denial of the application
Iowa City, Iowa 5 2240-1 826
(319) 356-5040 Last First Middle
(319) 356-5497 FAX 1. Name(REQUIRED) �E t_ bA Vd `/�
'�. 1 cr
2. Address(REQUIRED) J '-IDLj Pkuuk. e b C t ten 12A zo,s4 C >/ 1,,1d u
3. Contact Information (REQUIRED) Email: DQVId}(L4 sgo,Khoo tan Cell Phone:S l'.LI 7/-3S 33
(All written communication sent via email)
4a. Driver's License expiration date(REQUIRED)
b. Taxicab Business Name(REQUIRED) �i �eh "10J'I
5. Prior experience in transportation of passengers: 7-
6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? NO
Type of offense Where When
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? s%es
Type of offense Where 6 When
SPe- ,:f to wtpl7 U r 3c—S-5 vnp () Zones
What happened to the charge?(Circle one)
Convicted Dismissed Deferred Suspended Plead Gui ty Other
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? NO
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) , W
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
04/2018
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
c�
c,w', 17 '-k 4_ issued on 2 ` v" expiring on D I/J N ZD) } . I understand that if I
falsely answer any questions in this application, that this applicat' n may be denied. I agreb 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 provisions of Title
�5,,CChapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant 17(,i,�yt G'c�b Date y'Z 8-2_ 2
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by e A on this 2 a�t� day of
•
O ASHLEY A JAY-PLATZ Notary Public i n r th State to a
CunnnisAhi Mu.786698
iowl+ My Commission Expires
**********************************11**********, v47O*,********1********************,t***********************************,F**************,k**,t**
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).
Expirati date river's I' ense 0/ I Oq Jdo7
—10
yzr Z
Si nat e f 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.
1' + ilk. -` I �
Sig ature of City Clerk or designee Date
************************************************************************************************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
Clerk/TAXIDRIVBADGEAPPL92018amended.DOC 04/2018
Ii
SMARTER I SIMPLER II CUSTOMER BRINE � �!`:� dC7 ,g 7
Driver& eali1i tion Semites
PO Box 92Mi I Des Ines,,IA 628D34204
Roe: - :rU-9124,I Fax:5l5- 1 '
Certified Abstract of Driving Record
Inquiry Date: 3/17/2022 DL/ID#: 769YY9401 (IA) Customer#: 2348748
Name: Tiet, David Cuong Class: D ID Status: None
Address: 1404 PRAIRIE DU Audit#: 4282788 DL Status: VAL
CHIEN RD
Issue Date: 10/26/2019 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 i.y „ ro ;''
History Information + " `'' ki
Y,:r--- TT
Convictions ''Cil
Citation Date Conviction Date ACD Explanation County JUR
02/12/2014 02/24/2014 M14 Fail to Obey Traffic Johnson IA
Sign/Signal
02/14/2014 02/24/2014 N82 Improper Backing Johnson IA
03/08/2014 06/12/2014 M14 Fail to Obey Traffic Johnson IA
Sign/Signal
06/14/2021 06/17/2021 S92 Speed (10 mph& Johnson IA
under in 35-55 mph
zone)
Accidents - Accident involvement indicated does NOT mean the individual was at
fault or given a citation.
Accident Date Case Number JUR
01/27/2021 1223025 IA
Name:Tiet, David Cuong DL/ID: 769YY9401
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
Mar. 22. 2022 11 : 22AM DCI IOWA No. 5973 P. 2/3
fi:::-.-1
�-,, fi„3: �"` , ry pTE ®ry IO4A 4 1 � 1t ! D ., \/
, tr�„;.:
1•
ri T 1 , Criminal History Record Cheek + '
.. �, , , ;;,, .; r,„
- _ . tl A4 . — h.eQliLLIt t JJ . . . • . -. te �• I l _ •_
DCI Account Number:
(ifapplicnt3)
To: Iowa Division of Criminal Investigation From: City of Iowa City 7j
Support Operations Bureau,lu Floor City Cleric's Office;
215 E.'%n`Street 410 E.Washington Street ..Des Moines,)Iowa 50319 r- COO
(515)925-6066 Iowa CU .IA 52240' ,
(515)725-6000 Pax —.. . _
none: 319-356-5041 }
• Pam319-356-5497 .�...
rW}3
l am recLuesting an Iowa Criminal History Record Check on: _ `...
Last Name(mandatory) Inrst Name(mandatory) Middle 1191Ine(recommended)
'''-- -r_1_,E—±.,--- _ _ 1.)TR/16,1Ck ._... C
Date of Birth (mandat iy) Gender(mandatory) _ Social Security Numberirecomnended)
0 e —0 1,1 --: 9 '.7 0 .SEE Male OFemale 4 g 11 —0 4 ':- P-.1 C
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 criuiioal history record information,as allowed by law,always
obtain a waiver signature from the subject of the request. . .
Waiver Release:I hereby give permission for the above requesting official to conduct on Iowa criminal history record check with the Division of Criminal
Investigation(DCI). Any criminal history data concerning me that is maintained by the DCI may be released as allowed by law.
r 'f
Waiver Signature:_ f
Iowa Criminal r ig p__u &cord c911�cl 4sultIIlAas el C(Da 0only)
As of . - a search of the provided name and date of bixtli revealed: 9 .D� o.
O
No0 Iowa Criminal History Record found with DCI `\��•``� �.•• �','�r�r ''',,ro
'4:'
0 Iowa Criminal History Record attached,DCI# n ;bin a C j •t 1
• ory, nal A =
=/�•. esUltsr o
DCI lnittia1s �i s ; ,
DC1-77(08/25/10) '%,,,,j 'zt�ott .,%0�•��`���•
fYlHnuiiiim k.'