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CITY OF PORTLAND TAXI DRIVER LICENSE APPLICATION DO NOT WRITE IN THIS BOX App. Fee $56.00 Date Paid_________ CA/CK/CC City Badge#___________ Include Two (2) License Fee $ 75.00 Date Paid_________ CA/CK/CC Date Issued_________ Full Face 2” x 2” Passport Photos Maine License #_______________________ Expiration___________________ Do not staple or tape. Recommendation: Approved / Denied Date________________________ Reason for Denial 1.___________________________________ _________________________ ______ ___________________________ Last Name First Middle Home Telephone ___________________________________ _________________________ ____________________ Gender: M / F Any other names ever used by applicant Maine Driver’s License # Date of Birth _________________________________________________________________________________________________ Applicant Home Address City State ZIP Code _________________________________________________________________________________________________ Mailing Address Name of Cab Company 2.Have you lived in any other state during the last ten (10) years? Yes / No If Yes, please explain _______________________________________________________________________________ 3.Is your State of Maine driver’s license currently under suspension? Yes / No If Yes, please explain _______________________________________________________________________________ 4.Has your State of Maine driver’s license been suspended or revoked at any time during the past ten years? Yes / No. If yes, please explain ______________________________________________________________________ 5.Have you had any arrests or convictions for the following TRAFFIC VIOLATIONS during the past ten (10) years: reckless driving, driving to endanger, OUI or attempted OUI? Yes / No If Yes please list below: Year Offense Place Disposition _____ _____________________________ _________________ _____________________________ _____ _____________________________ _________________ _____________________________ 6.Have you ever been arrested, convicted, or imprisoned AT ANY TIME for any offense OTHER THAN traffic violations? Yes / No If yes, please list below: Year Offense Place Disposition _____ _____________________________ _________________ _____________________________ _____ _____________________________ _________________ _____________________________ 7.Do you own the taxicab to be driven or any taxicab business in Portland? Yes / No If Yes, what is the name of the taxicab company?_________________________________________________________ Please note there is a separate application and license for the taxicab business. 8.Does the award of this license benefit any City employee? Yes ____ No _____ If yes, please list name(s) and department(s) ____________________________________________________________ CERTIFICATION OF INFORMATION PLEASE READ CAREFULLY BEFORE SIGNING Applicant, by signature below, agrees to abide by all laws, orders, ordinances, rules and regulations governing the above license and further agrees that any misstatement of material fact may result in the refusal of license or revocation if one has been granted. It is understood that this and any application(s) shall become public record and the applicant hereby waives any rights to privacy with respect thereto. I hereby authorize the release of any criminal history record information to the City of Portland or licensing authority. I hereby waive any rights to privacy with respect hereto. I hereby acknowledge that I have read and understand Portland’s Vehicles for Hire Ordinance and I agree to abide by the same. Obligation of taxicab driver. It is the obligation of the licensed taxicab driver to notify the City of Portland of any suspension or revocation of his or her State of Maine driver’s license and to return his or her taxicab driver’s license to the License Administrator within fourteen (14) calendar days of such suspension or revocation. It is a violation of this ordinance for a licensee to continue to operate a taxicab vehicle after suspension of his or her state driver’s license and the taxicab driver’s license shall be suspended for up to a maximum of one year from the date of the finding by the City of such violation by a licensee, in addition to any other penalty which may apply under this article. Signature ____________________________________________Date___________________ Witness ____________________________________________Date___________________ (City of Portland representative) This application may take up to two weeks for processing. Any outstanding debts, judgments or tax payments in arrears that are due and payable to the City must be paid prior to issuing this license.
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