First Name:      Last Name: 

     Address:     

            City:      State:     

Postal Code:    Country: 

 Telephone Number:        FAX Number: 

Cell Phone Number:        Email Address: 

Sex:  Male    Female                               Citizenship: 

Are you authorized to work in the United States?  Yes      No

DRIVERS LICENSE:

Drivers License State:      Drivers License Number: 

Date of Birth:      January February March April May June July August September October November December   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 28 29 30 31    1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996                             

Country of Issue: 

PASSPORT:

Passport Number:      Expiration Date:  January February March April May June July August September October November December   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 28 29 30 31    1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996

PILOT CERTIFCATES:

Please check all that apply:

Certificates Held:  Commercial    ATP    FE    Airframe   Powerplant  Dispatcher  

Certificate Number: 

Certificate Country of Issuance: 

Total Hours:     Instrument Hours:    Night Hours:   Multi Engine Hours: Turbine Hours: 

Please check all that apply:

Single Engine Land  Multi Engine Land  Rotorcraft   Seaplane Balloon   Lighter Than Air    Other:

Type Rating 1:         Hours on Type      SIC       PIC     FE 

Type Rating 2:         Hours on Type      SIC       PIC     FE 

Type Rating 3:         Hours on Type      SIC       PIC     FE 

Type Rating 4:         Hours on Type      SIC       PIC     FE 

Type Rating 5:         Hours on Type      SIC       PIC     FE 

Type Rating 6:         Hours on Type      SIC       PIC     FE 

Type Rating 7:         Hours on Type      SIC       PIC     FE 

Type Rating 8:         Hours on Type      SIC       PIC     FE 

Type Rating 9:         Hours on Type      SIC       PIC     FE 

MEDICAL CERTICIATE:

Medical Certificate Country of Issuance: 

Medical Class:       Medical Date of Issue: 

Do you have any limitations on your Medical Certificate?  Yes     No

If yes, please explain: 

Have you ever pleaded "guilty" or "no contest" in court?  Yes   No

If yes please explain: 

Have you ever lost your Pilot Certificate, Medical Certificate and or Drivers License?  Yes    No

If yes please explain: 

Do you wish to be included on the Aeroservice Aviation Center Job Opportunity e-mail notices?  Yes       No

EDUCATION:  High School    Associates Degree    Bachelors Degree    Masters Degree   PHD

PREVIOUS EMPLOYMENT:  Please provide a brief description (Dates, Company Names and Position) for each of your previous employers.