Form 906 - Air Traffic Controller (Atc) Initial Licence/ Additional Rating & Exchange Application Page 2
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3Air Traffic Controller (ATC) - Initial Licence/
ARN:
Additional Rating & Exchange Application
3. Proof of Possession of ATC Licence
(Exchange Applications ONLY)
Licence Number
Date of Issue
_____ / ______ / ______
Attach a photocopy of your full licence including:
•
Front Page of existing licence showing date of issue.
•
Page showing ratings held
Section B: Qualified Air Traffic Service Workplace Assessor (ATS WPA)
Declaration
(Not required for Exchange applications) Mark all relevant boxes.
I,
___________________________________________ (full name of person certifying) declare that:
1. I have sighted documentary evidence that the applicant successfully completed a training course relevant to:
the licence, and/or
the rating(s).
2.
The applicant has:
Passed the appropriate written Rating examination(s),
Passed the appropriate written Endorsement examination(s), and
Been assessed by me and found competent to hold an Endorsement associated with each rating applied for.
3.
If applicable (for initial ATC Licence & additional ATC Rating(s) only):
English Language Proficiency (minimum Level 4) assessment completed on ______ / ______ / _______
Signature of ATS WPA
____________________________________________
Date signed
______ / ______ / _______
Aviation Reference Number (ARN):
The making of a false or misleading statement (including a statement which is misleading because of omission) in
an application for a Commonwealth licence, permit or authority is an offence under section 136.1 of the Criminal
Code, and is subject to a term of imprisonment up to 12 months.
Section C: Applicant Checklist*
Enter ‘Y’ or ‘N’ in applicable boxes.
I am at least 18 years old
Proof of possession of an ATC licence attached showing issue date & ratings (Exchange application
ONLY) OR
Not applicable
ATS WPA declaration complete OR
Not applicable (NOT required for Exchange application)
Payment made online and receipt attached OR
Payment Authorisation completed (cheque or money order attached if applicable)
All sections of the form are completed and I have signed the application declaration
Section D: Applicant Declaration*
I hereby certify that all statements in this application are true and correct in every particular and that I have read
and understood all regulatory references included in this application. I consent to CASA using and disclosing my
personal information in accordance with CASA’s privacy policy including exchanging the information with
Airservices Australia, Commonwealth, State and Territory government agencies (see ).
I have attached all required documentation specified in the applicant checklist and acknowledge that to knowingly
make a false statement is an offence against the Criminal Code Act 1995 (Cth).
Signature:
Date: _____ / _____ / _______
Form 906 09/2015
ATC Initial Licence/Additional Ratings & Exchange Application
Page 2 of 3
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