Pilot Application - Arizona Department Of Administration Page 2
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6FLYING EXPERIENCE IN LOGGED HOURS
PILOT-IN-COMMAND ONLY
SPECIIFY ALL MAKE AND MODELS
LAST 12
LAST 90
TOTAL LOGGED
MONTHS
DAYS
HOURS
ALL SINGLE
ENGINE
FIXED WING/GEAR
OR
RETRACTABLE
GEAR
MULTI ENGINE
PISTON
MULTI ENGINE
TURBINE
HELICOPTER
PISTON:
HELICOPTER
TURBINE:
AIRCRAFT INFORMATION
TYPES OF AIRCRAFT YOU OPERATE
YEAR
MAKE
MODEL
FAA#
STATE OWNED AIRCRAFT:
OWNED, BORROWED OR RENTED AIRCRAFT:
Borrowed or owned private aircraft (attach certificate of
insurance providing evidence of $1,000,000 minimum
Aircraft liability including passengers)
I CERTIFY THAT THE STATEMENTS I HAVE MADE IN THE PILOT APPLICATION TO BE THE
BEST OF MY KNOWLEDGE AND BELIEF.
PILOT SIGNATURE:_________________________________________ DATE:________________
APPROVED BY: ___________________ FOR SEFG SERG MEU HELI DATE:_______________
PILOT APP (5-04) KLR
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