PILOT APPLICATION

Mailing Address: 73-300 U'u Street - Kona International Airport - -Kona, Hawaii 96740
FAX: (808) 331-2079 - - - - VOICE: (808) 329-0018
Please print and complete this application, sign it, then return to us by FAX or MAIL along with letters of reference.
NOTE: Applications MUST include at least one letter of reference from a previous aviation employer to be considered.
MINIMUM ONE YEAR Employment contract is required.

Have you ever been convicted for violations of any law including traffic violations?_______ If yes, give in each case (1) date, (2) nature of violation, (3) name and location of court (4) disposition of case.

Within the past five years, under the drug testing provisions of FAR 121 Appendix I, have you tested positive or refused to submit to a required test?_______ If yes, please provide details:

Within the past five years, under the alcohol testing provisions of FAR 121 Appendix J, have you tested positive, refused to submit to a required test, or violated the ban on consumption of alcohol for 8 hours prior to duy?______ If yes, provide details:

Have you ever been involved in an aircraft accident?______If yes, provide details:

Within the past five years, have you not completed any training or checkrides due to performance?_____If yes, please provide details:

Within the last five years, have you been removed from flying status for any performance or professional competency reason?_____If yes, provide details:

Within the last five years, have you been the subject of any disciplinary action that was not subsequently overturned?_____ If yes, provide details:

The above information is true to the best of my knowledge (I understand that falsification of this application can result in immediate termination of employment).

ATTACH COPIES OF PILOT AND INSTRUCTOR LICENSES AND MEDICAL CERTIFICATE.
Applications will NOT be considered without an accompanying letter of reference from at least one prior aviation employer.

Note: It is the policy of this company, as well as a requirement by law enforced by the FAA, that employees whose duties include any safety-sensitive function submit to pre-employment and random testing for 5 illicit drugs, namely amphetamines, cocaine, marijuana, opiates, and phencyclidine (PCP).

Position Applying for:
Full Legal Name
Address
City, State, Country, Zip
Email Address
Driver License State and Number
Emergency Contact Name
Emergency Contact Phone No
Date of Birth
EDUCATION: High School and Location
College and Location

Home Phone:	Work Phone:	Fax:
Pilot Ratings:	Pilot License No:	SS No:
Total Flight Hours:	Cross Country Hrs:
Instructor Ratings:	Total Instruction Given:	Instrument Instruction Given:
Medical Class/Date:	Total IFR Flight Hours:	Total Multi Hours:

Employer - Address and Phone	Position	Dates	Monthly Earnings	Reason for Leaving
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