Warning...This form is under construction. IT will not transfer information to our office. PLEASE PRINT AND FAX THIS FORM TO 330-677-2351 (Insert information, print page to fax modem)
Use cut and paste method to e-mail Pilots@auto-jobs.com
First Name Last Name
Address City, State, Zip
Home Phone Work Phone Other Phone
E-Mail address
Are you interested in Full-Time (F) or Part-Time (P)
Where will you work: indicate states or cities (separate by commas)
The information you list here will help make the best match for you. This information will not be sold to list companies or be distributed in an unprofessional manner. Your transmitting the information to PILOT PLACE gives permission to check references, FAA records or any source needed to verify the information given.
Certificate Number
Social Security Number
Your Date of Birth
Current Medical Class Expiration date (m/y)
Your Certificates: Please indicate renewal dates (separate by commas)
Your Ratings (separate by commas)
Logged Hours in type:
Single Engine
Land Sea Amphibian Turbo Prop Turbo Jet
Multi Engine
Land Sea Amphibian Turbo Prop Turbo Jet
Rotor Piston Turbine
BREAKDOWN OF EXPERIENCE BY MAKE AND MODEL
In Command
Make/Model....total**last 90 day**VFRlast Yr*IFRlast YR*
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Second In Command
Make/Model....total**last 90 day**VFRlast Yr*IFRlast YR*
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FLIGHT TRAINING
List simulator training by aircraft,hours, date, and company
Are you currently enrolled in a Recurrent Flight program? List aircraft and training company>
List any programs or flight schools or other schools attended with dates
Current Insurance Carrier
EMPLOYERS
CURRENT OF LAST EMPLOYER
City State
Dates of employment Month/Year to
Income $per year
**PREVIOUS
City State
Dates of employment Month/Year to
Income $per year
**PREVIOUS
City State
Dates of employment Month/Year to
Income $per year
Thanks for completing this form accurately. This information will be used to earn you better jobs.
It may take several weeks to get a response, but you can call 330-677-3152 should you have any questions.
