Faa Form 8060-13 - National Driver Register Records Request (Pria)

Form Approved: OMB No. 2120-0607

Exp. 8/31/2010

NATIONAL DRIVER REGISTER RECORDS REQUEST (PRIA)

Pilot Records Improvement Act Of 1996 (PRIA)

Title 49 U.S.C. § 44703(h), RECORDS OF EMPLOYMENT OF PILOT APPLICANTS, as amended

Pursuant to 49 U.S.C. § 44703(h)(5), the NDR, as a person who receives a request for records under 49 U.S.C. § 44703(h)(1)(C),

shall furnish a copy of the requested NDR records concerning all applicants, not later than 30 days after receiving the request.

PART I: NATIONAL DRIVER REGISTER (NDR) RECORDS REQUEST

This request authorizes the National Highway Traffic Safety Administration (NHTSA) to perform a one-time file search of the

National Driver Register (NDR) for information pertaining to me, and to provide the results to the prospective employer listed

below. This search is to be limited to information about revocations or suspensions still in effect on the date of the request or

information entered into the NDR in the past 5 years from the date of the employment application. Upon my written request, the

prospective employer listed below shall make available to me any NDR information received as a result of this search.

_______________________________________________ , ________________________ , hereby requests records pertaining to:

(Air Carrier Name)

(Air Carrier Certificate #)

____________________________________ , ___________________________ , _____________________________

(Full Legal Name – first, middle, last)

(Date Of Birth)

(Social Security Number – optional)

________________________________________________________________________________________________

(Other Names Used – maiden prior name, nickname, professional name, other. If none, enter ‘none’)

______________________________________ , _______ , _______________ , _______________ , _____________

(Driver License Number and State)

(Gender)

(Eye Color)

(Height)

(Weight)

________________________________________________________________________________________________

(Mail the completed report to the requesting air carrier at this address)

PART II: CONSENT TO THE RELEASE OF RECORDS

Prospective Employee Understanding: I understand that the National Driver Register (NDR) search will result in a printed report,

which shall be sent only to the prospective employer listed on this form. The report will indicate either: (1) that the NDR does not

contain a records matching my identification; or, (2) that the NDR has a probable identification (pointer record) from one or more

states, which will be named on this report. A separate and additional check of state files, as a result of the pointer record, would be

required: (1) to verify the identification; or, (2) to obtain the driving record. Under the Privacy Act, I have the right to request

records pertaining to me from the NDR to verify their accuracy.

With my notarized signature, (If notarization is required) I hereby authorize a one-time file search of NDR related records

pertaining to me, with any and all resulting reports to be sent to the prospective employer named in Part I of this form.

__________________________________________________________________

______________________________

(Signature Of Applicant)

(Date Of Signature)

PART III: NOTICE TO THE PROSPECTIVE EMPLOYEE

Pursuant to Title 49 (U.S.C.) § 44703(h)(6) Records of Employment of Pilot Applicants, as amended, you are hereby notified, by

being provided with a completed copy of this form, that the above air carrier will submit an FAA Records Request (PRIA) for your

NDR related records. You are also notified of your right to receive a copy of any and all such records furnished by the NDR.

III(a). For Official ID Verification

III(b). Notarization

Date Received:

Date Sent:

Internal Control:

Required only if the NDR File Check Request is NOT made in

person by the prospective employee, or by the respective state.

___Valid Photo Driver License

___State Issued Photo ID

Sworn to and ascribed before me this_____day of __________

___Birth Certificate

___Valid Passport

In the city/county of_______________________state of_____

___Valid Military ID

___Military Discharge

___Other ___________________________________________

Signature of Notary Public_____________________________

(Indicate the specific type of identification used.)

Notary Public Seal:

___________________________________________________

Printed name and signature of person verifying identification.

Faa Form 8060-13 - National Driver Register Records Request (Pria) - 2005 Page 3

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