Cost is $35.00 for a yearly license including the $15.00 state DCI background check.
There are no refunds.
C I T Y O F C E D A R R A P I D S, I O W A
APPLICATION FOR PERMISSION TO DRIVE A MOTOR VEHICLE
FOR THE PURPOSE OF CARRYING PASSENGERS
NEW______ For City Clerk’s Office to fill out:
RENEWAL______ License #_______ License Expires___________
1. Name______________________________________________ List all additional last names ever used (alias
names, maiden names, previous married names)__________________________________________________
_______________________________ Which company do you drive for?_____________________________
2. Home address__________________________________________Telephone #_______________________
3. Birthdate________________ Age________ Place of birth________________________________________
4. Weight_________ Height__________ Color of Hair______________ Color of Eyes___________________
5. State Driver’s License #______________________________Social Security #________________________
6. Places of Residence in the last Five (5) years____________________________________________________
7. Places of Employment in the last Five (5) years__________________________________________________
8. Have you, within the past Five (5) years, been convicted of a felony or an offense involving moral turpitude
or sex abuse?__________If so, when and for what?________________________________________________
9. Have you been convicted of OWI charges or convicted of any moving violation which resulted in suspension
of an operator’s or chauffeur’s license within the past three (3) years? _________ If yes, when and for what?
10. Do you promise to always be neat and clean in person and dress?__________________________________
11. Do you have any physical defects which might impair your ability to drive?__________________________
12. Are you addicted to the use of intoxicating beverages?___________________________________________
13. Do you promise to abstain from the use of such while on duty?____________________________________
14. Can you read and write the English language?_________________________________________________
15. Do you have an Iowa Chauffeur’s License?___________________________________________________
(continue on the back side)
16. Do you fully understand that any falsification made hereinbefore will constitute grounds for revocation of
17. I authorize the City Clerk’s Office and Cedar Rapids Police Department to examine any and all criminal
history records and driving records held by the State of Iowa, other states and FBI as necessary?
Signature of Applicant
I, (print name) _________________________________________________, being first duly sworn, upon oath
depose and say that I am the proponent of the foregoing information, and that the statements made and answers
given above are true.
Date Signature of Applicant
Subscribed and sworn to before me this ________ day of __________________________________, 20_____.
Notary Public in and for Linn County, Iowa
Cedar Rapids Police Department: