Taxicab Operator License Application Form - Department Of Inspections And Permits - Anne Arundel County Maryland Page 2
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2Have you ever been convicted of a felony, misdemeanor, or other crime? ___YES ___NO
If YES, give the time, place and nature of each conviction.
Do you have any history of drug or alcohol abuse? ___YES ___NO If YES, please explain:
Have you ever been convicted of a motor vehicle violation? ___YES ___NO
If YES, list when and where and the nature of each conviction.
Have you ever been licensed as a taxicab operator? ___YES ___NO
If YES, when and where?
Have you ever had a motor vehicle license or taxicab license suspended or revoked? ___YES ___NO
If YES, please explain:
I, the undersigned, hereby apply for a taxicab operator’s license. I understand that the balance of the license fee must be
paid before a license can be issued. The information given herein is complete and accurate to the best of my personal
knowledge. If a license is issued to me, I will conform to and abide by all the laws and regulations applicable to taxicab
operators and vehicles. I understand that within twenty days of the issuance of a provisional taxicab operator’s license, I
must be fingerprinted and initiate a criminal history record request so that the report will be sent to the Department.
Within forty-five days I must provide evidence of physical examination by a physician. I further understand that any
changes to the information herein must be reported to the department in writing within forty-eight hours of occurrence.
If I leave the services of the cab company named herein, I understand that I must return my license to the company or the
department. I acknowledge that if I transfer to another company, I must submit an application and $25.00.
________________________
_______________________________________
Date of Application
Signature of Applicant
*************************************************************************************
This application is for a license to drive for ________________________________. Said cab company has
(name of company)
verified that this
applicant is knowledgeable of all relevant county laws and rules and that the applicant has
demonstrated an ability to follow directions and read a map. The following company representative certifies
these facts.
_____________________________________________
_________________________________
Signature of Company Representative
Printed Name
_____________________________________________
_________________________________
Title of Company Representative
Date
_________________________________________________________________
______________________________________________
Company Mailing Address
Company Telephone Number
Taxi Operator Provisional Application
Revised January 2013
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