*Please ensure you follow the "Guidelines KAL Application Form" when

completing this form.

APPLICATION
Rishworth Aviation
Fleet Rank Type-rating
Position Sought

Last Name First/Middle Name

Date of Birth Age

Nationality City of Birth

B Do you hold any other
A Gender
Passport(s)
S
I E-mail Skype Address
C
Telephone(Home) Mobile

Postal Address

Previous Application If Yes, When?

Previous Screening If Yes, When?

Currently Employed? If Yes, Where?

High School Name Completion?

S Year Entered Year Graduated
C Country City
H
O
O
University Name Completion?
L
I
Year Entered Year Graduated
N
G
Type of Degree Major Subject
Country City

Type Issuing Country

License No. Expiry Date

Licenses Effective Ratings

Do you hold Valid
Licence/s from any other Issuing Country
Country/ies?
ICAO English Proficiency Level Expiry Date

Medical Class 1 Expiry Date

CAT II/III Expiry Date

Type Ratings Expiry Date

Instrument Ratings Expiry Date

Accident/Incident If yes, When?
Police Record in Whole Life If yes, When?

Flight Experience SummaryTo be calculated based on DFE

Total Flying Hours

Total Multi Crew Jet Airline

Experience
Total Multi Crew Jet PIC Airline
Experience
Type-Rated Hours NTR Hours

Type-Rated P.I.C NTR P.I.C

FO hours counted toward PIC on Total FO Hours on
type Type
Co-pilot(FO)
Co-pilot(FO) Period
Hours
 DETAILED FLIGHT EXPERIENCE [DFE]
1. Airline Jet Transport Experience (Excluding Helicopter, Simulator, Observation)
Please separate First Officer and Captain experience and list in chronological order with most recent first. All experience in this top section equals Total Airline Transport Hours in the Flight Summary. Please complete all cells where required,
including Start and Finish dates.

Date Date Aircraft Type Name of Flight Hours Date of Last Date of Last Other Duties Reasons of
Position Remarks
Started Finished Fleet Other Airlines (Block to Block) Flight SIM Check LIP/LCP SIM Inst. Resignation

2. General Aviation Fixed Wing Jet / Turboprop Airline Transport Experience / Business Jet
Date Date Aircraft Type Name of Flight Hours Date of Last Date of Last Other Duties Reasons of
Position Remarks
Started Finished Fleet Other Airlines (Block to Block) Flight SIM Check LIP/LCP SIM Inst. Resignation

3. Military Experience (Excluding Back-Seat in Fighter)

Date Date Aircraft Type Name of Flight Hours Date of Last Date of Last Other Duties Reasons of
Position Remarks
Started Finished Fleet Other Airlines (Block to Block) Flight SIM Check LIP/LCP SIM Inst. Resignation

4. Fixed Wing Propeller-Driven Single/Multi Engine

Please include experience starting from cadet experience

Date Date Aircraft Type Name of Flight Hours Date of Last Date of Last Other Duties Reasons of
Position Remarks
Started Finished Fleet Other Airlines (Block to Block) Flight SIM Check LIP/LCP SIM Inst. Resignation

5. Captain Up-grade Training Record (Only for Captain) Please include your start and finish dates of all commercial command upgrades. Do not leave blank

Aircraft Type
Date Started Date Finished Name of Airlines Remarks
Fleet Other

6. Additional Information (Free Format)

I confirm the information provided on the Application and DFE is true and correct Signed: Dated:...

Please type your name by "Signed" and send file back to us In original Excel format. Pleased DO NOT scan or pdf.
AGENCY FLEET RANK NTR L_NAME F_NAME DOB AGE NATION CITY EMAIL

0 0 0 0 0 0 0 0 0
GENDER TEL MOBILE ADRS PRE_APP PRE_APP_DATE PRE_SCRN PRE_SCRN_DATE CURRENT C_NAME HIGH_NAME

0 0 0 0 0 0 0 12/30/1899 0
HIGH_FINISH HIGH_ENTER HIGH_END HIGH_NT HIGH_CITY UNIV_NAME UNIV_FINISH UNIV_ENTER UNIV_END UNIV_NT UNIV_CITY

0 0 0 0 0 0 0
DEGREE MAJOR L_TYPE L_NT L_NO L_DATE RATINGS ICAO ICAO_DATE MED MED_DATE

0 0 0 0 0 0 0 0
CAT CAT_DATE IR IR_DATE ACCIDENT ACC_DATE POLICE POL_DATE TTL_H TTL_ATPL_H TTL_PIC_H

0 0 0 0 0:00 0:00 0:00

TR_H NTR_H TR_PIC_H NTR_PIC_H FO_PERIOD FO_H A1_START A1_FINISH A1_FLT A1_OTH A1_NAME

0:00 0:00 0:00 0:00 0:00:00 0:00 0 0 0

A1_POS A1_H A1_LAST A1_SIM A1_LICP A1_INST A1_RZN A1_RMK A2_START A2_FINISH A2_FLT

0 0:00 0 0 0 0 0
A2_OTH A2_NAME A2_POS A2_H A2_LAST A2_SIM A2_LICP A2_INST A2_RZN A2_RMK A3_START

0 0 0 0:00 0 0 0 0
A3_FINISH A3_FLT A3_OTH A3_NAME A3_POS A3_H A3_LAST A3_SIM A3_LICP A3_INST A3_RZN

0 0 0 0 0:00 0 0 0
A3_RMK A4_START A4_FINISH A4_FLT A4_OTH A4_NAME A4_POS A4_H A4_LAST A4_SIM A4_LICP

0 0 0 0 0 0:00 0
A4_INST A4_RZN A4_RMK A5_START A5_FINISH A5_FLT A5_OTH A5_NAME A5_POS A5_H A5_LAST

0 0 0 0 0 0 0 0:00
A5_SIM A5_LICP A5_INST A5_RZN A5_RMK A6_START A6_FINISH A6_FLT A6_OTH A6_NAME A6_POS

0 0 0 0 0 0 0 0
A6_H A6_LAST A6_SIM A6_LICP A6_INST A6_RZN A6_RMK A7_START A7_FINISH A7_FLT A7_OTH

0:00 0 0 0 0 0 0
A7_NAME A7_POS A7_H A7_LAST A7_SIM A7_LICP A7_INST A7_RZN A7_RMK A8_START A8_FINISH

0 0 0:00 0 0 0 0
A8_FLT A8_OTH A8_NAME A8_POS A8_H A8_LAST A8_SIM A8_LICP A8_INST A8_RZN A8_RMK

0 0 0 0 0:00 0 0 0 0
A9_START A9_FINISH A9_FLT A9_OTH A9_NAME A9_POS A9_H A9_LAST A9_SIM A9_LICP A9_INST

0 0 0 0 0:00 0 0
A9_RZN A9_RMK A10_START A10_FINISH A10_FLT A10_OTH A10_NAME A10_POS A10_H A10_LAST A10_SIM

0 0 0 0 0 0 0:00
A10_LICP A10_INST A10_RZN A10_RMK G1_START G1_FINISH G1_FLT G1_NAME G1_POS G1_H G1_LAST

0 0 0 0 0 0 0 0:00
G1_RZN G1_RMK G2_START G2_FINISH G2_FLT G2_NAME G2_POS G2_H G2_LAST G2_RZN G2_RMK

0 0 0 0 0 0:00 0 0
M1_START M1_FINISH M1_FLT M1_NAME M1_POS M1_H M1_LAST M1_RZN M1_RMK M2_START M2_FINISH

0 0 0 0:00 0 0
M2_FLT M2_NAME M2_POS M2_H M2_LAST M2_RZN M2_RMK F1_START F1_FINISH F1_FLT F1_NAME

0 0 0 0:00 0 0 0 0
F1_POS F1_H F1_LAST F2_START F2_FINISH F2_FLT F2_NAME F2_POS F2_H F2_LAST C1_START

0 0:00 0 0 0 0:00
C1_FINISH C1_FLT C1_OTH C1_NAME C1_RMK Add_INFO_1 Add_INFO_2

0 0 0 I confirm the information provided on the Application and DFE is true and correct Signed: Dated:... Please type your name by "Signed" and send file back to us In original Excel format. Pleased DO NOT scan or pdf.