1 .us
|1. Name of Pilot (Last, First, MI) |PA Dept. of Conservation & Natural Resources |
| | |
|2. Mailing Address |Bureau of Forestry |
| | |
|3. City, State, Zip |Pilot Approval Form |
| | |
|4. Home Phone |5. Age |6. Marital Status | |
| | | | |
|7. In the Event of an Emergency Notify: |
|A. Name |B. Street Address, City, State |C. Phone |D. Relationship |
| | | | |
|8. Employer Information |
|A. Name of Employer |B. Employment Terms (Fulltime, Year Long, Seasonal, etc.) |
| | |
|9. Airman Certification Information |
|A. Type |B. Check All Appropriate |C. Certificate Number |
|ATP | |COM |
|yes | |no | | | |
|G. Last Instrument Comp Check |H. Medical Class |I. Issue Date |J. Limitations to Airman Certificate or Medical |
| | | | |
|10. Flight Hour Information |11. Air Tanker Flight Hour Information |
|. |Total |Multi Engine |Past 12 Months | |
|A. Pilot |Hrs |Hrs |Hrs |Approval Applied for |
| |12. Last Approvals Issues (Interagency Carding, etc.) |
|G. Experience from Designated Base, Number of Seasons: | |
| |Attach/Scan a Copy of Interagency Card To/With This Form. |
|13. Related Schools Attended Last 5 Years (Forest Service or Other) |
| |
|14. Any Previous Approval Denied, Suspended, or Revoked? If Yes, Explain: |
| |
|Certify that the Statements Made Hereon are True. |
|15. Signature of Applicant: |Date: |Attested to by Employer (Signature Required) |Date |
| | | | |
1 Jan 2009 Edition BoF Pilot Approval Form 09
THIS FORM MUST BE SIGNED BY A REPRESNTATIVE OF THE EMPLOYER TO BE ACCEPTED.
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