This transcription has been completed. Contact us with corrections.
Date Name (Attach Photo If Possible) Address Telephone Number Membership Number Age Marital Status Number of Dependents Education AIR LINE EXPERIENCE Date Hours First Reserve Copilot Company From To Type of Aircraft MILITARY EXPERIENCE Hours First Copilot Branch Type of Aircraft TOTAL For Hdqs. Use only (Air Line Hours) (Military Hours) (Other Hours) GRAND TOTAL COMMERICAL RATINGS Is your Department of Commerce License still in force? Class and Number Date Issued Do you hold an Instrument Rating? Do you hold an Air Transport Rating? When Issued Is it active? Do you hold a Seaplane Rating? Class Last Air Line Employed by Date of Release Position Held Cause of Release