HomeMy WebLinkAboutDrivBadgeAPP 07-2018 REVISED IDENTIFICATION NO. ___________________
(Office Use Only)
04/2018
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 Last First Middle
1. Name (REQUIRED)
2. Address (REQUIRED)
3. Contact Information (REQUIRED) Email: __________________________________ Cell Phone:
(All written communication sent via email)
4a. Driver’s License expiration date (REQUIRED) ______________________________________________________
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?
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?
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?
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)
Clerk/TAXIDRIVBADGEAPPL92018amended.DOC 04/2018
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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
_____________________________________ issued on ___________expiring on ______________. 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_________________________________ Date_______________
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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 Iowa
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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 ___________________________________
Signature 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.
Signature of City Clerk or designee Date
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Office Use Only
Approved application
DCI report
State certified driving record
Website update