PILOT APPLICATION FORM

(confidential)

PERSONAL RECORDS

FirstName

Family Name

Address

Post code and Place

photo Telephone no. (Home)

Telephone no. (Work)

Telephone no. (Cellular)

Social sec. no. (AVS-AHV)

Date of Birth

Marital Status

Email

Available from

Nationality

Passport/Identity Card no. Expiry Date

Country of Issue

Visa (if applicable) Date of Exp.

Working permit Date of Exp.

Date of last medical check Class

Height (Metres) Weight (Kgs)

Children

Name Age Date of Birth Sex Citizenship Occupation

EDUCATION

Year/s Level Diploma COURSES

OTHER

Year/s Level Diploma

LANGUAGES COURSES

Year/s Level Diploma

LANGUAGES

Describe as: mother tongue, excellent, good, satisfactory or poor

Language Spoken Written Italian

English

French

German

Spanish

Other:

SKILLS

COMPUTER

Programs

Hobby/Sport

Hobbies

Able to swim ? Yes No

Sports

References

Personal

address Name Email

Work

Company’s name Name Position Email address

LICENCES

(For terminology see legend at page 9)

Type Country Number Date of Issue Date of Expiry ATPL 1

ATPL 2

IFR

CPL (A)

CFI (VFR)

CFII (IFR)

MEI (M.ENGINE)

TYPE RATING

MCC

INITIAL FLYING TRAINING (To ACPL, ATPL or Military Equivalent)

Civilian/Military Training Organisation Country Qualification Year

Graduated

EMPLOYMENT RECORDS

From M/Y

To

M/Y

Employer Position

Aircraft

types

Current

type present

FLYING HOURS SUMMARY

Notes:

(1)In Command time should only include the time when operating as the company nominated Pilot in Command.

(2)For Military aircraft types use the common civilian name.

(3)Where there is a substantial difference in variants of same type (e.g. B737-200 & B737-300) list separately.

a b (a+b)

In command Co-pilot Total Simulator F/E, Navigator or 2nd Officer

(1) Multi-Engine Jet “A”

Type

Date last

flown

Sub-Total

“A”

a b (a+b)

In command Co-pilot Total Simulator F/E, Navigator or 2nd Officer

Multi-Engine Turbo-Prop “B”

Type

Date last

flown

Sub-Total

“B”

a b (a+b)

In command Co-pilot Total Simulator

F/E, Navigator

or 2nd Officer

S/E Military Jet “C”

Type

Date last

flown

Sub-Total

“C”

a b (a+b)

In command Co-pilot Total Simulator

F/E, Navigator

or 2nd Officer

Multi-Engine Piston

Type

Date last

flown Sub-Total “D”

a b (a+b)

In command Co-pilot Total Simulator F/E, Navigator or 2nd Officer

S/E Turbo-Prop / Piston “E”

Type

Date last

flown Sub-Total “E”

TOTAL (A+B+C+D+E)

Helicopter

EFIS Total EFIS Aircraft types

Total Hours in the last 12 months Total Sectors in the last 12 months

CAT II/III qualification and validity

Last flight on Saab 2000

Airport qualification,validity and last flight Route Experience

RHS qualification and validity

Medical certification and validity Security Training (SEC – 12) Emergency and Safety Equipment Training (ESET – 12)

CRM recurrent (12)

Line Check (LC - 12)

Dangerous Goods (DG – 24)

Please enclose:

•Letter of motivation;

•Curriculum Vitae;

• 2 passport size photos (not older than 6 months);

•Original Excerpt from the Swiss criminal record;

(for foreign pilots please enclose the original form issued by the country of residence) •Copies of Diplomas;

•Copy of aeronautical (JAR) medical certificate;

•Copies of working certificates;

•Copy of the working permit (if applicable);

•Copies of licences;

Legend:

Rules

Flight

IFR Instrument

CPL (A) Aircraft Commercial Pilot Licence

CFI/VFR Certified flight instructor/Visual Flight Rules

CFII/IFR Certified Flight Instrument Instructor/Instrument Flight Rules

MEI/M. Engine Multi Engine instructor

T. Rating Type Rating

MCC Multi Crew Coordination

ATPL 1 Airline Transport Pilot Licence (if obtained in Switzerland)

ATPL 2 Airline Transport Pilot Licence (if obtained outside Switzerland)

Engine

S/E Single

EFIS Electronic flight instrument system

Seat

Hand

RHS Right

DG (24) Dangerous Goods within 24 months

SEC (12) Security Training within 12 months

ESET (12) Emergency and Safety Equipment Training within 12 months

CRM rec. (12) CRM recurrent within 12 months

LC Line Check within 12 months

I authorize Darwin Airline SA to obtain references to support this application and release the Company and referees from any liability caused by giving and receiving such information.

I declare that the information contained in this form is true and complete and that I have not withheld any information that may affect my suitability for employment with Darwin Airline SA.

I understand that if it is subsequently discovered that any statement is false or misleading or that any information has been withheld, I may be dismissed from employment by Darwin Airline SA.

Place & Date: ……………………………………… Signature: ………………………………………….