0 U.S. Deportment

F01mApproved: OMB No. 2120-0607 08/3112010

FAA RECORDS REQUEST (PRIA)

Pilot Records Improvement Act Of 1996 (PRIA) of Ttonsporrorion

Federal Aviation T itle 49 U.S.C. § 44703(h), RECORDS OF EMPLOYMENT OF PILOT APPLICANTS, as amended Administration

Requests for FAA records should be addressed as follows: Regular mail tluough the United States Postal Service (USPS): Expedited mail service through the USPS or private canier:

Federal Aviation Administmtion Federal Aviation Administration Attn: Aviation Data Systems Branch, AFS-620 (PRIA) Attn: Aviation Data Systems Branch, AFS-620 (PRIA) PO Box25082 6500 S. MacAlthur Blvd., ARB Room 313 Oklahoma City, OK 73125-0082 Oklahoma City, OK 73169

NOTICE

Request will not be deemed valid unless Parts I and II are completed as specified in the instructions.

Pursuant to 49 U.S. C. § 44703(h)(5), the FAA, as a person who receives a request for records under 49 U.S. C. § 44703(h)(J)(A), slwllf urnish a copy o_{ the requested FAA records to ALL applicants, not later than 30 days afler receiving the request.

PART 1: FAA RECORDS REQUEST (PRIA)

ATJ .RCTTANT Am , WXQ8 1561 , hereby requests records pettaining (Air Car rier Name) (Air Can ie1· Ce1·tificate #)

to the airman consenting in Part II below conceming: (i) cunent airman medical cettificate; (ii) current airman certificates indicating level, categ01y, class, and associated type ratings, including any limitations to those cettificates and ratings; and, (iii) summaries of legal enforcement actions resulting in a finding by the Administrator of a violation of Title 49 U.S. C. or a regulation prescribed or order issued under this Title that was not subsequently overtumed [as provided by 49 U.S. C. § 44703(h)(l)(A)].

Name: Hir~Right R~r~~~ntativ~ Title: EBI8LDOI ~eritkations (P1i nt - Air Canier Representative) (P1i nt-Title of Air Can ie1· Representative)

Signature: Date: (Air Car rier Representative)

Mailing address: HIRERIGHT- ATTN: PRIA DEPARTMENT

14002 EAST 21st STREET, SUITE 1200

TULSA, OK 74134

Telephone (800) 331-9175 FAX (866) 895-1348

PART II: AIRMAN CONSENT FOR THE RELEASE OF RECORDS

I , consent to and authorize the Federal Aviation Administration

(P1i nt - Airman's First, Middle, and Last Name)

to release records conceming: (i) my current airman medical cettificate, (ii) current ailman certificates indicating level, categ01y, class, and associated type ratings, including any limitations to those certificates and ratings; and, (iii) summaries of legal enforcement actions resulting in a. fmding by the Administrator of a violation by me of Title 49 U.S.C. or a. regulation prescribed or order issued tmder this Title that was not subsequently overtumed, to the air canier named in Patt I above.

Airman Certificate Number(s):

Signature: Date: (Not valid unless signed and dated)

*Mailing address:

(*Indicates required information. See Instructions: Part II, item 4)

Telephone:

FAA Form 8060-10 (10-05)

u.s. Deporrmenr of Transportation

Federal Aviation Administration

INSTRUCTIONS

FAA FORM 8060-10, FAA RECORDS REQUEST (PRIA)

Pilot Records Improvement Act Of 1996 (PRIA) Title 49 U.S.C § 44703(h), RECORDS OF EMPLOYMENT OF PILOT APPLICANTS, as amended

Air caniers should use this f01m to request FAA Records from the Federal Aviation Administration as contemplated under 49 U.S.C. ~ 44703(h). Requests may be mailed or FAXED to 405-954-4655, ATTN: PRIA.

NOTICE

Request will not be deemed valid unless Parts I and II are completed as specified below.

This f01m may be photocopied for use. This f01m is available at http://www.faa.gov/pilots/lic cert/pria/ or http://forms.faa.gov/ A separate form must be used for each ainnan whose records are requested. DO NOT enter information on this form such as date of birth, social security number, or other information for which the airman may have a reasonable expectation of privacy. *Mailing address - See Part II Item 4.

Part I- FAA Records Request (PRIA): To be completed by the hiring Air Carrier.

All entries must be completed legibly with black or dark blue ink.

1. N rune, title, and signature - enter the name, title, and signature of the person making the request on behalf of the air canier.

2. Date- enter the date of the request. 3. Mailing address - provide a complete company mailing address to which FAA will mail the requested records.

Part II- Airman Consent For The Release Of Records: To be completed by the Airman/Applicant.

All entries must be completed legibly with black or dark blue ink.

1. Nrune- enter your name as it is shown on your ainnan ce1tificate(s). 2. Allman Ce1tificate Number- enter your aiiman ce1tificate number(s). In parenthesis after the ce1tificate number,

indicate the type of ce1tificate by using C (Commercial), A (Aii·line Transp01t Pilot), F (Flight Instructor), or G for (Grmmd Instr11ctor) . If you have multiple ce1tificates with the same ce1tificate number, list the ce1tificate number once and indicate the types of ce1tificates in pru·enthesis. For example, if you hold an Aii·line Transp01t Pilot Ce1tificate as well as Flight Instmctor and Ground Instmctor Ce1tificates using the srune number, you should indicate as follows: Ce1tificate No. 456231234 (A, F, G).

3. Signantre and Date- Sign in ink using your legal signamre, then enter the date of the request. 4. *Mailing Address- All applicants must ensure that their mailing address, as maintained in FAA records, is

complete, accurate, and current. All FAA records mailed to the applicant as the result of a PRIA request, will, for security purposes, be mailed to the address as maintained by the FAA. The applicant, however, should still enter their current mailing address in Part II for confirmation of the valid address.

PAPERWORK REDUCTION ACT STATEMENT Title 49 United States Code ( 49 U.S. C.) § 44703(h), Records of Employment of Pilot Applicants, as runended, requii·es all air caniers to request FAA records and Au· Cru1ier and Other Records conceming an individual before allowing that individual to begin service as a pilot. 49 U.S.C. § 44703(h)(8) requii·es the FAA Administrator to promulgate standard f01ms to request records. The inf01mation entered on the standard f01ms will be used to facilitate the seru·ch and retrieval of the requii·ed records. It is estimated that the average burden per respondent associated with this collection ofF AA Records is 10 minutes. The requii·ement to collect and evaluate background inf01mation on the pilot, before allowing that pilot to begin service, is mandat01y; however, the use of this f01m is not, although it is highly recommended. An agency may not conduct or sponsor, and a person is not requii·ed to respond to, this request for inf01mation unless a cunent and valid OMB contr·ol number is prominently displayed. The OMB control number assigned to this collection is 2120-0607. Comments conceming the accuracy of this burden and suggestions for reducing the burden should be dii·ected to the FAA at: 800 Independence Ave SW, Washington, DC 20591 , Attil: Inf01mation Collection Clearance Officer, ABA-20.

FAA Form 8060-10 (10-05)

us Department of Transportation

Federal Aviation Administration

F01m Approved: OMB No. 2120-0607 08/31/2010

AIRMAN NOTICE AND RIGHT TO RECEIVE COPY- FAA RECORDS (PRIA)

Pilot Records Improvement Act Of 1996 (PRIA) Title 49 U.S.C. § 44703(h), RECORDS OF EMPLOYMENT OF PILOT APPLICANTS, as amended

NOTICE

Title 49 U.S. C. § 44703(Jr)(6) requires tile person receiving a records request to notify tile individual who is tile subject of the request within 20 days after receiving the request, and further entitles tile individual tile rigllt to receive a complete copy of aU FAA records furnished in response to the request wit/tin 30-days after receiving the request.

Title 49 U.S. C. § 44703(Jr)(7) allows for a reasonable charge for the cost of processing tile request and furnishing copies ofthe requested records.

PART I: AIRMAN NOTICE AND RIGHT TO RECEIVE COPY

(Airman Name- First, Middle, Last) (Airman Certificate #)

Pursuant to 49 U.S.C. § 44703(h)(6), you are hereby notified that ALLEGIANT AIR --------~------------------------~ (Air Canier Name)

WXOA 1561 submitted an FAA Records Request (PRIA) dated .---------~-------------------(Air Carrier Certificate Number) (Date of Request)

for your records conceming: (i) cunent aliman medical ce1tificate; (ii) cunent aliman ce1tificates indicating level, categmy, class, and associated type ratings, including any limitations to those ce1tificates and ratings; and, (iii) summaiies of legal enforcement actions resulting in a finding by the Administrator of a violation of Title 49 U.S.C. or a regulation presciibed or order issued lmder this Title that was not subsequently ove1tumed [as provided by 49 U.S.C. § 44703(h)(l )(A)].

You are hereby notified of your light to receive a copy of any and all records fumished by the Federal Aviation Administration in response to the aforementioned records request, and that you may request a copy of such records by checking yes, signing, and dating in Pmt II below. Refer to the NOTICE in the attached instructions.

PART II: AIRMAN REQUEST OR NON-REQUEST FOR RECORDS

D YES, I want a copy of the fumished records. D NO, I do not want a copy of the fumished records.

(Signature) (Not valid unless signed and dated) (Date)

*Mailing address: ------------------------------------------------------------------(*Indicates required information. See Instructions: Part II, item 3)

Telephone:

FAA Form 8060-lOA (10-05)

U.S. Deportment ot Tronspatotion

Federal Aviatior Administration

INSTRUCTIONS

FAA FORM 8060-lOA, AIRMAN NOTICE AND RIGHT TO RECEIVE COPY- FAA RECORDS (PRIA)

Pilot Records Improvement Act Of 1996 (PRIA) TITLE 49 U.S.C § 44703(h), RECORDS OF EMPLOYMENT OF PILOT APPLICANTS, as amended

NOTICE

Request will not be deemed valid unless completed as specified below. This f01m may be photocopied for use. This f01m is available at http://'www.faa.gov/pilots/lic cert/pria/ or http://forms.faa.gov/ A separate fo1m must be used for each airman whose records have been requested. DO NOT enter information on this form such as date of birth, social security number, or other information for which the airman may have a reasonable expectation of privacy. *Mailing address- See Part II Item 3. IMPORTANT: If the applicant receives initial notification of a records request from the hiring air carrier by being provided with a completed and signed copy of Form 8060-lOA, which serves as a written notification to the airman lAW 49 U.S.C. § 44703(h)(6), further use of this form is not required. Only Form 8060-10 is to be forwarded to the FAA to request records. All applicants, regardless of whether they have indicated a preference for the receipt of a copy of their records, will be provided with a copy of their PRIA Pilot Profile Letter that is maintained by the FAA and furnished, as requested, to the hiring air carrier. The hiring air carrier maintains the original Form 8060-lOA.

Part I-Airman Notice and Right To Receive Copy: To be completed by the Air Carrier preparing an FAA Records Request (PRIA). All entries must be completed legibly with black or dark blue ink.

1. Allman's name and ce1tificate number - enter the name and certificate number of the individual who is the subject of the request on FAA F01m 8060-10, FAA Records Request (PRIA).

2. Ail· catTier name and ce1tificate number- enter the name and ce1tificate number of the air canier making the request on FAA F01m 8060-10, FAA Records Request (PRIA).

3. Date- enter the date of the request listed on FAA F01m 8060-10, FAA Records Request (PRIA).

Part II -Airman Request or Non-Request For Records: To be completed by Airman/Applicant. All entries must be completed legibly with black or dark blue ink.

1. YES or NO- check the appropriate box to indicate whether you DO or DO NOT want a copy of the records fmnished. If requested, copies will be mailed to the mailing address provided. (Refer to the above NOTICE)

2. Signan1re and date - sign in ink using yom legal signature, then enter the date of the request. 3. *Mailing address - All applicants must ensure that their mailing address, as maintained in FAA records, is

complete, accurate, and current. All FAA records mailed to the applicant as the result of a PRIA request, will, for security purposes, be mailed to the address as maintained by the FAA. The applicant, however, should still enter their current mailing address in Part II for confirmation of the valid address.

4. Refer to the above NOTICE. Fmnish the applicant with a completed and signed copy ofFonn 8060-lOA, thereby providing a written confi1mation that a records request will be made and a copy ofF AA records will be received.

PAPERWOJK REDUCTION ACT S1l.TEMENT Title 49 United States Code (49 U.S.C.) § 44703(h), Records of Employment of Pilot Applicants, as amended, requires all air caniers to request FAA records and Air Can ier and Other Records conceming an individual before allowing that individual to begin service as a pilot. 49 U.S.C. § 44703(h)(8) requires the FAA Administrator to promulgate standard fo1ms to request records. The info1mation entered on the standard fo1ms will be used to facilitate the search and retrieval of the required records. It is estimated that the average bmden per respondent associated with this collection ofF AA Records is 10 minutes. The requirement to collect and evaluate background info1mation on the pilot, before allowing that pilot to begin service, is mandato1y; however, the use of this f01m is not, although it is highly recommended. An agency may not conduct or sponsor, and a person is not required to respond to, this request for info1mation unless a cmTent and valid OMB control nmnber is prominently displayed. The OMB control nmnber assigned to this collection is 2120-0607. Comments conce1ning the accmacy of this bmden and suggestions for reducing the bmden should be directed to the FAA at: 800 Independence Ave SW,

Washington, DC 20591, Attn: Info1mation Collection Cleamnce Officer, ABA-20.

FAA Form 8060-lOA (10-05)