Airborne Training - Flight Deck Crew Information Form

Airborne Training and Management Services Inc.

Fax:
Fax: 416-679-9501
Or by post:
80 Galaxy Boulevard, Unit #20
Toronto, Ontario, Canada M9W 4Y8

FLIGHT DECK CREW INFOMATION FORM

NOTE: Complete all questions and declarations and ensure that the employment record is continuous. If space allowed for any question is insufficient, use a separate sheet. Please attach photocopies of passport and all licences currently held.

LAST NAME: ______________________________________________________

FIRST NAME: _____________________________________________________

POSITION INTERESTED IN: __________________________________________

If interested as a Captain, would you accept a F/O position if Captain vacancies are already filled ? YES _____ NO _____

PREFERRED TYPE (If applicable): ______________________________________

TODAY’S DATE: ___________________________________________________

AVAILABILITY / NOTICE PERIOD: _____________________________________

ADDRESS: _______________________________________________________

________________________________________________________________________

TEL #: ________________________ FAX #: ___________________________

CELL #: _______________________ E-MAIL: __________________________

DATE OF BIRTH: ________________ PLACE OF BIRTH: __________________

NATIONALITY AT BIRTH: _________ PRESENT NATIONALITY: _____________

PASSPORT NUMBER: _____________ VALID UNTIL: ______________________

NAME: __________________________________________________________

EMPLOYMENT RECORD
DATES FROM TO	NAME OF COMPANY	COUNTRY	AIRCRAFT TYPE	POSITION HELD

FLYING LICENCES
LICENCE TYPE/ VALIDATIONS	LICENSING COUNTRY	TYPE RATINGS	NUMBER	DATE FIRST ISSUED	VALID UNTIL

MEDICALS: CLASS/DATE:

__________________________________________________

A) Are there any Restrictions/Limitations on your current Medical Certificate
(e.g. Glasses or Contact Lens, specifications).
Please give details:
_______________________________________________________________________

B) Has any Medical Certificate issued to you in association with any flying licence ever been suspended or revoked:

YES _____ NO _____

C) Have you ever been refused a Medical Certificate:

YES _____ NO _____

If yes in (B) or (C), give details below :
__________________________________________________________________

__________________________________________________________________

NAME: ___________________________________________________________

TOTAL FLYING HOURS
FLYING HOURS, BY TYPE
AIRCRAFT TYPE	TOTAL TIME	CAPTAIN TIME	CO-PILOT TIME	F/E TIME	INSTRUCTOR TIME	DATE OF LAST FLIGHT







TOTALS

TRAINING/INSTRUCTOR QUALIFICATIONS
WHICH AIRLINE	ON WHAT TYPES	SPECIFY APPROVALS i.e. LINE BASE, SIM, CAA, FAA

ACCIDENTS/INCIDENTS

Have you been involved in any aircraft accidents or incidents

YES _____ NO _____

If yes please give details below:
___________________________________________________________________________________

_________________________________________________________________________

I AUTHORIZE AIRBORNE TRAINNING & MANAGEMENT SERVICES INC. TO DISCLOSE ALL OR ANY OF THE ABOVE INFORMATION TO INDIVIDUALS OR COMPANIES FOR THE PURPOSE OF SEEKING AVIATION EMPLOYMENT.

I HEREBY DECLARE THAT THE INFORMATION GIVEN IS CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF, AND THAT I HAVE NOT WITHHELD ANY INFORMATION WHICH MIGHT REASONABLY BE CALCULATED TO ADVERSELY AFFECT MY SUITABILITY FOR EMPLOYMENT.

SIGNATURE: ______________________ DATE: _________________________