ATTENTION APPLICANT:
Convictions may NOT necessarily lead to the denial of your application.
Applicant’s Signature: Date:
***TAXICAB AUTHORITY USE ONLY***
Application/Background reviewed by Taxicab Authority Investigator.
TA Investigator Name: P# Date:
Application/Background: Pass Fail
Nevada Taxicab Authority
State of Nevada - Business and Industry
2090 E. Flamingo Road Suite 200
Las Vegas Nevada 89119
Telephone (702) 668-4000 • Fax (702) 668-4001
http://taxi.nv.gov
TA320 CrimHstyStmt (7/23v2)
Application fees paid will not be refunded in the event you are denied a taxicab drivers
permit.
All convictions, arrests, and dispositions must be disclosed regardless of their date or
location.
By making this application, I
hereby consent to an investigation of my character, reputation,
employment, and criminal records. I hereby waive any claim of privilege or privacy and agree
the Nevada Taxicab Authority may contact any individual, firm, or agency necessary to conduct
such Investigations. Any person, firm, or agency that furnishes information about me pursuant
to this consent and waiver shall not be liable for any loss or damage I may suffer by reason of
the release of said information.
I hereby swear and affirm that the information contained herein is true. I further acknowledge
that “ANY” false statement or omission on this application form may result in the denial of my
driver’s permit application (new or renewal) or revocation of my Taxicab Authority permit.
GROUNDS FOR DENIAL!