Portland Taxi Driver License by PermitDocsPrivate


									                                           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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