REQUIREMENTS FOR NEW APPLICATION FOR TAXICAB DRIVER IDENTIFICATION CARD

1. Physical:

Each applicant must have the physician statement signed.

2. Copy of Recent Driving Record:

This record must include the prior six month driving experience. The record must be obtained no more than 2 weeks before submission of the application. TAXICAB DRIVER IDENTIFICATION CARDS ARE NOT ISSUED TO APPLICANTS WHO HAVE MORE THAN 4 POINTS ON THEIR DRIVING RECORD.

3. Recent Photographs:

You must submit 1 side view and 3 front view photographs. The side view must be a profile with your shoulder facing the camera (a correct profile includes a side view of the nose and one eye). These pictures must be color prints, passport size. No hats or sunglasses are permitted in the photographs.

4. Application notarized:

The application must be notarized by a Notary Public. A Notary Public is usually available in the taxicab office.

5. Fingerprints: (2 SETS) - COMPLETE IN BLACK INK.

Call one of the following Montgomery County Police Stations prior to going to the location to be sure there is staff available to do fingerprinting. You must bring two forms of ID with you to the police station. Be sure the officer fingerprinting you signs both fingerprint cards.

(OFFICE USE ONLY)

DATE RECEIVED FOR PROCESSING: _________ BY: _________ ID #: _______
TEMP. ISSUED (Y/N): _______ TEMP. EXPIRATION DATE:____________
PERM. ISSUED DATE: ____________ BY: _________ EXPIRATION DATE:______
TEST DATE: ___________________ RESULTS: ______________

ANY PERSON WHO MAKES A FALSE STATEMENT UNDER OATH TO ANY QUESTIONS ON THIS FORM SHALL NOT BE ISSUED A CARD TO OPERATE A TAXICAB. ALL QUESTIONS ON THIS APPLICATION MUST BE ANSWERED.

HOME ADDRESS: ______________________________________________APT. NO: ______
CITY/STATE: __________________________ZIP:____________PHONE NO:(      )_________
SOCIAL SECURITY # _________________ or ALIEN REGISTRATION CARD # ___________
DRIVER'S LICENSE NUMBER: _________________________STATE:______CLASS:______
AGE:_____ DATE OF BIRTH: __________________ HEIGHT: _______ WEIGHT: ________
SEX:_____ EYE COLOR: _________ HAIR COLOR: __________

1. Where were you born? ______________. If not born in the United States are you a naturalized citizen? ______. When were you naturalized? _______
2. How long have you had a driver's license? ___________________.
3. Have you ever plead guilty, been convicted or forfeited collateral on any charge other than a traffic violation? ______ If yes, please list convictions. .

If you need additional space, continue on a separate sheet.

4. Name of Company for which you will drive. ____________________________________

5. Have your driving privileges ever been suspended, revoked or denied in any state or jurisdiction? ________. If so, why? ____________________________________

6. Have you ever filed an application to be a taxicab driver in the past? _______________

If so, when and where?___________________________________

____________________________________________________________________________

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In consideration of the granting of this license, I agree that I will conform to and abide by the Taxicab Regulations for Montgomery County, Maryland and swear that I have answered all questions completely and truthfully.
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______________________being duly sworn, deposes and says that _____________________ is the individual making the foregoing application for a Taxicab Driver's Identification Card; that the answers to the foregoing questions and other statements contained therein are true to the best of __________________ knowledge and belief.

Sworn to before me this ________ day of __________________ 19 ____.

_____________________________

NOTARY PUBLIC

____________________________________________________________________________

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PHYSICIAN'S VOUCHER

This is to certify that I have examined _____________________________ and I find the applicant is not subject to any physical or mental impairment or other condition that could adversely affect the applicant's ability to drive safely or otherwise endanger the health, safety, or welfare of the public.

If physician is unable to certify the above, please explain: ____________________________
____________________________________________________________________________
____________________________________________________________________________
___________________ ___________________________________

DATE SIGNATURE OF PHYSICIAN
ADDRESS: ___________________________________
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