GARDENA POLICE DEPARTMENT OFFICE OF BUSINESS LICENSE NOTICE TO TAXI PERMIT APPLICANTS

All individuals applying for a taxi permit must complete and submit the following:
1. TAXI Permit Application.
2. TAXIPermit Questionnaire.
3. A photocopy of a current California Driver’s License or California Identification Card.
4. Request for Live Scan Service. This form must be taken to one of the specified locations on the attached list, whereupon the applicant’s fingerprints will be taken and processed. A non-refundable fee must be paid at the time of fingerprinting.
5. A non-refundable application fee must be paid at the time of application to the City of Gardena,
by cash.

ALL DOCUMENTS AND FEES MUST BE SUBMITTED TO THE GARDENA POLICE DEPARTMENT / CITY OF GARDENA
6. If you are applying for a work permit for one of the classifications below, you must provide the taxi permit - must complete a written test as to his/her knowledge of traffic regulations and the geography of the city.

TAXI PERMIT APPLICATION
(Type or print clearly in ink)
1. Name of Applicant:
Last First Middle
2. Job Title:
3. Name of Business Establishment:
4. Business Establishment Address:
5. Business Telephone Number: ( )
I understand that this application is a public document. Any information provided on this form
will be available for public inspection (Business & Professions Code §19820).
Applicant Signature Date
Owner or Hiring Agent Signature Date
NOTICE AN APPLICATION MAY NOT BE WITHDRAWN WITHOUT THE PERMISSION OF THE CHIEF OF POLICE

TAXI PERMIT QUESTIONNAIRE
Type or print clearly in ink an answer to every question. If the space available is insufficient, use a separate sheet and precede each answer with the appropriate question number. If a question does not apply to you, so state with “N/A.” Do not misstate or omit any material fact(s) as each statement made herein is subject to verification.

You are advised that this personal history record is an official document. Any misrepresentation or failure to reveal requested information may be deemed to be sufficient cause for the denial of your application, or revocation of your permit.

NAME OF TAXI BUSINESS ESTABLISHMENT:
1. PERSONAL INFORMATION:
Last Name First Name Middle Name
Alias(es), Nicknames, Maiden Name, Other Name Changes, Legal or Otherwise
Present Resident Address City, State, Zip Home Phone Number (Include Area Code)
Occupation:
Social Security No. Driver License No. State Issued Expiration Date
Date of Birth Place of Birth (City , State)
Sex:
Male
Female
Eye Color Hair Color Weight Height Race/Ethnicity
Marks, Scars, Tattoos:
Are you a United States Citizen Yes No Resident Alien: Yes No Alien Registration No.
If Naturalized, Certificate No. Place of Naturalization
Date:
2. RESIDENCE: excluding your current residence, list all residences you have had for the last 3 years.
Month and Year
From - To
Street and Number City State / Zip Code

EMPLOYMENT: Beginning with your current employer, list all places of employment where you have
worked during the last 3 years.
Name of Employer Location Job Title Month / Year
From - To
Reason for Leaving
4. CRIMINAL HISTORY (Convictions Only):
A. Have you ever been convicted of a felony? Yes No
B. Have you been convicted of a misdemeanor within the past 10 years? (Convictions dismissed pursuant to Penal Code section 1203.4 must be disclosed) Yes No
C. Are you currently on probation? Yes No
If your answer to 4 A. Or B. Was “yes” provide details here
Date of Arrest
Arresting Agency
Location - City & State
Original Charge
Final Charge
(if amended or
reduced)
Disposition (dismissed, not guilty, convicted or expunged)
5. LICENSING HISTORY:
A. Have you ever applied to any local, state or federal governmental agency for a Work employee
permit, badge, or licensing in any state? Yes No
If your answer to 5 A. Or B. Was “yes” provide details here
If you have been denied, revoked or withdrawn an application, provide details here
Local Government Agency Type of Application
Approved or
Denied Dates Held
Reasons for Denial,
Revocation or Suspension
B. Have you ever been denied a work permit or license by law enforcement agency, or had any
such permit or license revoked or suspended?
any
Yes No
6 of 9
Declaration
STATE OF
COUNTY OF
I, , attest that I have read the foregoing Work Permit Questionnaire and know the content thereof; that the statements contained herein are true and correct and contain a full and true account of the information requested; that I executed this statement with the knowledge that misrepresentation or failure to reveal information requested may be deemed sufficient cause for denial or revocation of my permit. I declare under penalty of perjury that the foregoing is true and correct.

Executed this day of , 20 , at
State
Signature of Applicant
City,
AFFIX ONE PASSPORT QUALITY PHOTOGRAPH TAKEN WITHIN THE LAST 30 DAYS
AFFIX PASSPORT
QUALITY PHOTOGRAPH
HERE
Date of Photograph
7 of 9
GARDENA POLICE DEPARTMENT
1718 West 162nd Street Gardena, California 90247
Phone: 310-217-9670 Fax: 310-217-9638
Rod Lyons, Chief of Police
www.gardenapd.org

YOU ARE NOT PERMITTED TO DRIVE A CAB IN CALIFORNIA, GARDENA CITY UNTIL YOU HAVE OBTAINED A TEMPORARY OR PERMANENT TAXI PERMIT.
During the 90 days, an extensive background check will be conducted and your fingerprints will be submitted to the Department of Justice to determine any criminal background. If the background is completed and there are no problems related to your fingerprints, then you will be permitted to obtain a permanent work permit for the time frame specified under the City of Gardena Municipal Code.

If there are problems noted in your background or on your taxi permit application, you will be notified either by mail or by the licensing detail as to the problem. If the Police Department denies the permit, you have the right to file for an appeal with the City Clerk’s Office. The appeal process will be explained to you at the time of appeal or within the denial letter that is sent to you.