Pilot Information
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AIRMAN CERTIFICATES HELD
Type
Date Issued
Certificate Number
A. Airline Transport Pilot
B. Commercial Pilot
C. Private Pilot
D. Flight Instructor
E. Mechanic
F. Flight Engineer
G. Medical Class
1st/
2nd/
3rd
RATING RECORD
Indicate certificate privileges for ratings below by showing appropriate letter in column 1.
Indicate Flight Instructor Rating in column 2, where appropriate.
Rating
Flight Instructor
Airplane Single Engine Land
Airplane Single Engine Sea
Airplane Multiengine Land
Airplane Multiengine Sea
Instrument Airplane
Instrument Helicopter
Glider
Helicopter
Gyroplane
Classification of Flying Hours
Total Hours to date
Weight Class
Type and Total Hours
Total Last
12 months
Pilot
-in-
Command
Co-Pilot
Airplane
make
and
model
under
12,500
lbs.
over
12,500
lbs.
Pilot
-in-
Command
Co-Pilot
Flight Engineer
A. Total Pilot Time
B. Single Engine
C. Twin Engine
D. Four Engine
E. Multiengine Less Than 12,500 lbs. Gross Weight
F. Multiengine More Than 12,500 lbs. Gross Weight
G. Jet
H. Actual Instrument
I. Hood Instrument
J. Synthetic Trainer
K. Flight Simulator
L. Rotorcraft
M. Night
N. Primary Instructor
O. Advanced Instructor
P. Instrument Instructor
Q. Multiengine Instructor
R. Scheduled Air Carrier
S. Military Scheduled
T. Other Military
U. Executive Transport
V. Total Hours Last 12 months
W. Total Hours Last 6 years
Previous employment history
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