Angel Airlift Mid-Atlantic-Pilot Application Form printable pdf download

Angel Airlift Mid-Atlantic-Pilot Application Form

Angel Airlift Mid-Atlantic

Volunteer Pilots Providing the Shortest Distance Between Home and Hope

Pilot Application

Please print or type all information

NAME (Last/First/Middle)__________________________________________Date________/_______/________

DATE OF BIRTH______/______/______ WEIGHT_________ SPOUSE__________________________________

MAILING ADDRESS______________________________CITY__________STATE_________ZIP____________

DAY PHONE:(

)________-_________________ NIGHT PHONE:(

)________-____________________

FAX:(

)_________-________________CELL:(

)_____________-________________________________

EMAIL_______________________________________________________________________________________

BUSINESS (Company Name and Job Title)__________________________________________________________

HOME BASE (Airport Name)_______________________________(3or4 Character ID)______________________

FBO and PHONE_________________________________________(

)___________________________________

TOTAL TIME__________IFR___________MULTI_________X-CTRY___________AS OF______/______/______

Pilot Certificate #___________________________Medical Expires______/______/______Class 1_____2_____3_____

FAA License:______________Private________Commercial_________ATP________Instrumented Rated __________

Has your license or medical certificate ever been revoked or suspended? Yes_______ No________

(If Yes, please explain the circumstances on a separate sheet and attach it to the application)

Veteran: Yes _________ No__________

IDENTIFY AIRCRAFT YOU CAN SUPPLY FOR MISSIONS

Make

Model

Own

# of seats

Single or

IFR Cert

FLT

Pressurized

Deicing

twin

Y/N

Plan

Rent

Speed

Angel Airlift Mid-Atlantic-Pilot Application Form