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Home My WebLink About22-004 r IDENTIFICATION NO. 22- 0 0 _ 1 (Office Use Only) --- ��_- i ii;;:111,4214:211A ti ft. iielgosiqr 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 4 I 0 East Washington Street Failure to complete the "required"information will result in denial of the application Iowa City. Iowa 52240-1 826 (319) 356-5040 Last First Middle (319) 356-5497 FAX i" 1. Name(REQUIRED) -rVtUell) —11Mi h I1 2. Address(REQUIRED) \ 14 OH 1''( , `�y Q buCh°'iL✓h 4d 2w11 C6 t TA S.)2 cJ C p / 3. Contact Information (REQUIRED) Email: Cell Phone: i ( 4.3 S6- Li 3 (All written communication sent via email) 4a. Driver's License expiration date(REQUIRED) b 1 /0 (-i/ 2 0 Z b. Taxicab Business Name(REQUIRED) MI "jr, --r ax; 5. Prior experience in transportation of passengers: T 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? A 0 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? avv I/LS T e of offense W here W h n 3153b(*j1i&1c (0 CL i II Io)a.D[°( What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspended lead Gui Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A/0 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) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) l,/,/' 04/2018 ti 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 Transportatio a,v lid Driver's license number n C n. f h.A or issued on c.i xpiring on O n ( 2oZ(� I understand that if falsely answer any questions in this application, that this ap lica' n may be denied. I a ree at in making this application, I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to xamine 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 Date oh - 1 STATE OF IOWA ) COUNTY OF JOHNSON ) -y� apZZ Subscribed and sworn to before me by -Fri van. Lcu u i rU pvl•. on this o•Q Jc day of re WENDY S.MAYER (> Com Cj (�` • mssO. Numbs►729428 Notary Pub in and for the ate o Iowa �c cif • 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 orwelfare of resi- dents of the City of Iowa City(Title 5, Chapter 2, City Code). Expirat�i a o er's license Ole /w000 � en3�j 7 Signat -Petice ief 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. —'> — �— Signature of City Clerk designee J Date ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update Clerk/TAXIDRIVBADGEAPPL92018amended.DOC 04/2018 .0. add.lo g i ot gov SMARTER I SIMPLER I CUSTOMER DRIVEN — _ -__ __._.- Drivel'&ld tifti at oon.ServIess PO sox 9214 I Des Moirt .IA vtta a. Irma 44-9'i I Fax:5 1fr -f$ 7 Certified Abstract of Driving Record Inquiry Date: 3/17/2022 DL/ID#: 433ZZ6758 (IA) Customer#: 1542644 Name: Truong,Trinh Cam Class: D ID Status: None Address: 1404 PRAIRIE DU Audit#: 4282777 DL Status: VAL CHIEN RD Issue Date: 10/26/2019 CDL Status: None City/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 _ e History Information Convictions Citation Date Conviction Date ACD Explanation County 7UR.J 11/10/2019 11/14/2019 M14 Fail to Obey Traffic Johnson IA co Sign/Signal 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: os T ' r ., 3/17/2022 i�� .4 ,, 6A Driver&Identification Services Mar. 22. 2022 11 : 22AM DCI IOWA No. 5973 P. 1/3 ,SDI u;!��;-i i' a o r,;.,. .. Criminal History Record Check �_.. �, ;-. . . / ;,„ V\kV•14'/0./ DCI Account Number: (if applc tible) r--.s 1o: Iowa Division of Criminal Investigation )Fro>fat: City of Iowa City :-. Support Operations Bureau,Its`Floor City Clerk's Office - ' 215 E.7th Sti-cet 410 E.Washiagto Street,1,- Des Moines,Iowa 50319 — . (.5i15)'725-6066 Iowa City, rA 52240 L1,, __;,.., (515)725-66080 Fax - Phone: 319-356-5041 • 3X9�3S6-5497 Faze: `'� I am requesting an Iowa Criminal History Record Check on: X,asil Name (mandatory First Name(mandatory) Mktldle Name(recommended) Date of Birth (,nandalory Gentler(mandatory) Social Security Number (recommended) (r) , (c ) °Male I Fe nnale k g 5 G 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 complete criminal 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 an Iowa criminal history record check with the Division of Criminal Investigation(DCI). Any criminal history data concerning me chat is maintained by the DCI may be released as allowed by law. Waiver Signature: Vt ,-al. `►•1•r It®wal C1�@ltIl9in if 11[is>t®>r° �c02`_ Check 1[��>r>t,Y�s (DCI use only) As of 2-9 a , a search of the provided name and date of birth 11 re •I � m a.( Criminal `��t�tniluthnn rpiniiy� n f� tl/.Q�pi No Iowa History Record fou>zd with DCI �� , �iqc h? r0 Iowa Criminal History'Record attached,OCX# 42 � ▪ r !,anal '▪A = • - hlstor r Et DCI initials li S. Y •=Sult5: S-' -� DCI-77 (08/25/10) ��i�de,• .'•......• �tiQ� ��` .ter �� , oral;,,,, ser' .., Mar. 22. 2022 11 : 22AM DC I IOWA No. 5973 P. 3/3 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 Includettin this response. A signed-release-authorization is not sufficient-10 obtain this information-from-the-Bivlsisn-ofGriminsl-Investigation-n-order-to-r-equest the-Felease-of confidential juvenile records, if any, an application must 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: httpi/www.iowasexoffender.com/. However, even though some information is available on this site, the actual records for juveniles 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(18).