Pilot Application Form
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1
218260 Edison Avenue, Suite A
Chesterfield, MO 63005
Phone: 636.735.2222 Fax: 636.735.2223
PILOT APPLICATION (COMPLETE ENTIRE FORM)
PILOT HISTORY
NAME:
PHONE:
ADDRESS:
E-mail:
CITY:
STATE:
ZIP:
(select state)
MEDICAL CLASS:
MEDICAL EXPIRATION:
No
PILOT'S CERTIFICATE #:
Yes
Willing to Relocate:
CURRENT TYPE(S) AIRCRAFT FLYING:
HOURS IN AIRCRAFT(S) IN LAST 12 MONTHS:
HOURS IN AIRCRAFT(S) IN LAST 6 MONTHS:
HOURS IN AIRCRAFT(S) IN LAST 90 DAYS:
If the answer to question 1-8 is yes, an explanation is required at the bottom of page 2.
YES
NO
1. Have you ever had any aircraft accidents or incidents?
2. Have you ever been charged or convicted of a misdemeanor or felony?
3. Have you ever been cited for violations of civil/military aviation regulations?
4. Are you flying subject to limitations or a waiver?
5. Has your driver's license ever been suspended or revoked?
6. Have you ever been arrested for operating a vehicle while under the influence of
alcohol or drugs?
7. Have you ever failed an alcohol or drug test at a previous employer?
8. To the best of your knowledge, is there anything that would cause you to fail the
required TSA background and security check?
9. Do you have previous 135 experience? (explanation not required)
10. Do you have previous 121 experience? (explanation not required)
CERTIFICATES / RATINGS
Indicate all certficates you currently hold:
Student
ATP
Single Engine Land
Private
Instructor
Multi Engine Land
Commercial
Instrument Rating
ATP Written (if no ATP)
List all aircraft type ratings you currently hold (include SIC type ratings):
Date/Location of Last Training:
Total PIC Time in Type:
Aircraft Type:
Total Time in Type:
Pilot App. (SJ-3/17) - Rev. 9
Page 1
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Parent category: Business