民用航空器驾驶员执照和等级申请表

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1、民用航空器驾驶员执照和等级申请表ApplicationforCivilAircraftPilotLicenseand/orRating用墨水笔或打印填写所有项目TypeorPrintAllEntriesinInkI基本信息BasicInformation照片Photo(蓝底彩色小2寸)Small2inchbluebackground1姓名(汉语及全拼)Name2国籍Nationality3出生日期DateofBirth年Y月M日D4性别Sex□男Male□女Female5出生地PlaceofBirth6民族(中国籍)ChineseOnly

2、7联系电话Telephone8通讯地址MailingAddress9邮政编码ZipCode10工作单位ServiceOrganization11永久住址PermanentResidenceAddress12身份证明名称TypeofIdentificationDocument□身份证ID□其它Others13身份证明编号IdentificationDocumentNo.14学习简历Education起止年月Period校、院、专业及取得的学位School,College,MajorandDegree15工作经历Experience起止年月P

3、eriod在何地、何部门、任何职务Location,ServiceOrganizationandTitleII申请信息ApplicationInformation16是否持有或曾经持有过CAAC颁发的驾驶员执照？DoyouholdaCAACPilotLicense?□是Yes□否No17a执照编号LicenseNo.17bFN编号FNSerialNumber18颁发日期DateofIssue年Y月M日D执照到期日期DateofExpiration年Y月M日D19持有CAAC颁发的有效的体检合格证等级□I□II□III□IVWhichcla

4、ssofthevalidCAACMedicalCertificatedoyouhold?20体检合格证有效期至__年___月___日DateofExpirationYMD21你能正确读、听、说、写汉语吗？Canyouread,hear,speakandwritetheChineselanguage?□是Yes□否No22已持有哪国ICAO英语语言能力等级签注WhichlevelandwhichCountyofICAOEnglishProficiencyLeveldoyouhold?□是Yes颁发国Country等级Level□无No23是

5、否有处罚记录？WhetheryouhavearecordofPenalty?□无No□有Yes□行政处罚AdministrativePenalty□警告Warn□罚款Fine□暂扣Suspension□吊销Revocation处罚日期DateofPenalty_____________________□刑事处罚CriminalPenalty处罚日期DateofPenalty_________________说明Explanation______________________________________________________

6、_________24a申请执照或等级ApplicationInformation□初次申请InitialApplication□增加等级AdditionalRating□执照更新Renewal24b申请执照或等级ApplicationInformation□运动驾驶员执照SportsPilotLicense□私用驾驶员执照PrivatePilotLicense□商用驾驶员执照CommercialPilotLicense□多人制机组驾驶员执照Multi-CrewPilotLicense□航线运输驾驶员执照AirlineTransportP

7、ilotLicense□仪表等级InstrumentRating□型别等级TypeRating□基础教员等级FlightInstructorRating□仪表教员等级FlightInstructor-InstrumentRating□型别教员等级TypeRatingInstructorRating□运动教员等级SportInstructorRating填写附件1Fillinattachment1填写附件2Fillinattachment2填写附件3Fillinattachment3填写附件4Fillinattachment4填写附件5Fi

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