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Date _____ _ Applications can take up to 60 days to review <br />AFFIDAVIT OF APPLICANT FOR TAXICAB DRIVER'S LICENSE <br />Full Name ---------------------------------(First) (Middle) (Last) <br />Present Address _______________________________ _ <br />(Number & Street) (City) (State) (Zip Code) <br />Length Of Time At Present Address____ Phone Number# ____________ _ <br />List Residence (s) For T he Past Five (5) Years: Dates <br />Month & Month & <br />Full Address City State Zip Year To Year <br />Age __ _ Height ___ _ Weight. ___ _ Sex__ Date of Birth_/_/_ <br />Social Security# XXX-XX-___ _ Driver's License# ___________ _ <br />(Address on license MUST match current address) <br />Have you ever held a driver's license from any other state? If so what state __________ _ <br />EDUCATION <br />Name Full Address I High School I Colle <br />Circle Grade <br />Completed <br />9 10 11 12 <br />1 2 3 4 <br />EMPLOYMENT HISTORY (BEGIN With Most Recent Employer for the last 10 YEARS) <br />Dates of Service Full Address, City, <br />Company Mth/Yr thru Mth/Yr State, Zip <br />Phone <br />Number Position Supervisor