Sunnyvale Taxi Driver Permit Application by PermitDocsPrivate


									                        TAXICAB DRIVER PERMIT APPLICATION

       Name of Taxicab Company: __________________________________Date: ____________
                    _____First Permit ______Renewal _____ Change of Companies
Name of Driver (include any aliases or previous names used)/ attach copy of drivers’ license:
_________________________________________________Date of Birth: ________________________
Height________ Weight________ Hair_________Eyes________Telephone #:_____________________
Home Address: ______________________________________City/Zip___________________________
Social Security #: _________________________ Drivers License#_______________________________
Employment History:
Begin with most recent/current employer and list past employers for the last five years. Use a separate
sheet of paper if more space is needed.
         Employer                    Dates Employed                  Reason for Leaving
Driving Information:
Has drivers’ license ever been refused/suspended/ or revoked? Explain circumstances including dates and
places of occurrence.
Traffic Violations: Date of Citation Violation Issuing Agency    Fine/Penalty
Criminal History: Listing fraudulent or misleading statements or omission of facts WILL result in
a denial of your Taxicab Driver application.
Have you ever been convicted of a felony crime? ____No ____Yes. If yes, explain including
date/location of conviction.
Have you been arrested for a misdemeanor crime within the last five years? ____No ___Yes. If yes,
please explain; include the date/location of conviction.
***As a condition of this permit, the undersigned acknowledges and agrees to the following:

It shall be unacceptable to refuse to transport passengers who present themselves for carriage in a
sober and orderly manner and for a lawful purpose when the vehicle is in service and not otherwise
engaged (SMC 5.36.180). This is intended to prevent drivers from discriminating against a person
on the basis of trip length, or on the basis of race, ethnicity, or gender. It is not intended to require
the driver to transport a person whom the driver knows has not paid a fare in the past, or who
presents a threat to the safety of the driver. Failure to comply with this condition will result in the
revocation of said permit.

I hereby certify that the statements made on this application are true and I am fully aware that making
a false statement or failure to disclose information may disqualify me from being granted a permit. I
understand that all fees are non-refundable per Sunnyvale Municipal Code Section 5.36.340.

________________________________________                  _______________________
       Signature of Applicant                             Date

I have a valid franchise to operate within the City of Sunnyvale and I intend to employ the above
named person as a driver in Sunnyvale if s/he obtains a permit. I acknowledge that it is my
responsibility to ensure this person follows all of the franchise agreement rules.

_________________________________________                 ________________________
       Signature of Cab Co. Designee                      Date


                            DRUG AND ALCOHOL TEST RESULTS

California Government Code Section 53075.5 requires compliance with a mandatory controlled substance
and alcohol testing certification program as a condition for issuance of a taxicab driver’s permit. The
approval of a taxi driver permit by the Director of the Sunnyvale Department of Public Safety is
conditioned upon the Department’s receipt of this authorization to obtain and release the results of all
drug and/or alcohol tests and for any refusal by the applicant to undergo such testing.

                                   APPLICANT AUTHORIZATION

I authorize the City of Sunnyvale Department of Public Safety to obtain my drug and/or alcohol test
results. I also authorize the Sunnyvale Department of Public Safety to obtain any refusal by me to
undergo such testing from other law enforcement agencies, previous employers, and consortiums.

I authorize the City of Sunnyvale Department of Public Safety to release all test results obtained pursuant
to this authorization, along with any refusal by me to undergo such testing, to other law enforcement
agencies for the purpose of taxicab licensing/permitting.

_____________________________            __________________________
Applicant’s Printed Name                  Applicant’s Signature

_______________________________ __________________________
Applicant’s Social Security Number     Date


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