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1
PILOTAPP001
ISS 01 REV 00 01 JULY 2018
Thank you for your interest to join Flight Deck position in Manta Air. We are looking forward to receiving your complete application.
Position applied for: Captain First Officer
Current Position: Current Aircraft Type:
Current Employer: Notice Period:
Inclusive of your notice period, how long would it take you to join Manta Air?
Present Postal Address:
Permeant Address:
Office Tel:
Mobile Tel:
E-Mail:
Date of Birth (DD/ MM/YY):
City of Birth:
Country of Birth:
(Present) Nationality:
Do you hold Dual Nationality: Yes No
If yes, please specify:
NIC/Passport Number: Place of Issue:
Date of Issue: Date of Expiry:
Name:
Title First Middle Last
Personal Details
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PILOTAPP001
Marital Status:
Single Married Divorced Separated Widowed
Please state your ICAO English Proficiency Level:
Please note the following when entering your Flying Hours; 1. For aircraft type, include variants. For example, if you have flown the ATR 72-500, ATR 72-600 & ATR 42-500
show them as separate entries. A single entry showing total hours on all three types is not acceptable 2. Hours should be rounded to the nearest hour 3. Command hours should only include time when operating as the nominated Pilot-in-Command (PIC) 4. Please do not include simulator hours
Aircraft Type
Hours Flown as
Airline Commander Copilot
P1 Date of Last Flight
P1 U/S P2 Second Officer
Date of Last Flight
(Cruise Capt)
Total
Total Flying Hours =
Flying Experience
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PILOTAPP001
When & Where did you receive your professional flying training and Type Rating?
Do you have an outstanding bond with your current employer: Yes No If yes, please specify the amount in US$: Reasons for leaving last position:
Has your license ever been revoked or suspended? Yes No If yes, please specify:
Have you ever been involved in any aircraft accidents or incidents? Yes No If yes, please specify:
Have you ever been employed in an appointment / training capacity? Yes No If yes please specify:
Type of flying
license
Issuing
authority
License
number
Date of
1st issue
Date of
expiry
Limitations
Medical class Date of Last Medical Date of Expiry Issuing Authority
Flight Deck Information
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PILOTAPP001
Please Indicate your last 5 employers
Name and city of employer
Dates
Position Held
Reason for Leaving
Gross Annual Salary
Package From To
MM YY MM YY
Qualifications achieved / Degree
received
Dates
From To
MM YY MM YY
Secondary
education
University /Tertiary
Education
Business /
Professional
Other
Please indicate your competency in different languages [B = basic; I = intermediate; F = fluent; M = mother tongue]
Language
Read
Write
Speak
Language
Read
Write
Speak
Employment & Educational Background
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PILOTAPP001
Please give at least 3 Professional Reference from Previous Airlines (please mentioned airlines e-mail address only – personal e-mail address is not accepted)
1 Name
Address
Position / title
Telephone
E-Mail address
2 Name
Address
Position / title
Telephone
E-Mail address
3 Name
Address
Position / title
Telephone
E-Mail address
Please provide us with the details of your Chief Pilot (current Employer)
Name
Telephone
E-Mail address
Please provide us with the details of your HR Manager (current Employer)
Name
Telephone
E-Mail address
References
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PILOTAPP001
Have you ever been convicted of criminal offence? Yes No
If yes, please provide details:
Have you ever required medical treatment or
Counseling for drug or alcohol abuses? Yes No
If yes, please provide details:
Do you have any relatives employed by
Manta Air or any of its subsidiaries? Yes No
If yes, please provide details:
Do you have any relatives employed by
Manta Air or any of its subsidiaries? Yes No
If yes, please provide details:
Please state why you wish to join Manta Air?
Please tell us how you imagine your potentials life in Manta Air, one year from now!
Please mention any specific qualities or further details that you feel may assist us in placing you in employment!
Miscellaneous
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PILOTAPP001
Please fill out the medical section of this questionnaire. These questions are additional to the medical and do not replace it. As with the general application form, providing false details or intentionally suppressing required information will render you liable to disqualification, or, if appointed, result in automatic termination and / or appropriate legal proceedings.
General Questions
Height [in cm]: Weight [in kg]:
Do you have any pre-existing medical condition / illness? Yes No
If yes, please provide details:
Have you been grounded for medical reasons or has the renewal of your license ever
been deferred on medical grounds? Yes No
If yes, please specify:
Do you wear a) Glasses Yes No
b) Contact lenses Yes No
If yes, please provide details Specify
Do you suffer from colour blindness? Yes No
Do you smoke? Yes No
If yes, please tell us how much you smoke:
Do you drink alcohol? Yes No
If yes, how much do you drink per week?
“I hereby confirmed that all data mentioned above is valid and correct. All false and untruth information that identified in the future would have a consequence on my application or my employment. Meanwhile, any outstanding documents and qualifications requirement, would be completed accordingly.
(…………………………………….)
Name and Signature
Medical Section
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PILOTAPP001
a. Please attach the application form along with the following mandatory copy documents:
Passport, showing all relevant details and still valid for min 2 years
CV with mentioning reference from 2 previous airlines
Flying license(s) (ATPL / CPL + IR, with valid rating endorsed)
Medical Certificate
Last two simulator checks
The last three pages of the logbook (Must be stamped by last employer)
Proof of English proficiency
A recent formal passport photo
License Verification Letter
Training Certificates (e.g. CRM, Dangerous Goods, Fire Fighting, etc)
Reference Letter from previous employers
b. Email all application to:
Manta Air
Human Resource Department
Required Documents to be Attached with this Form