Exhibit 5 Airplane Pilot Qualification record.pdf
PDF 395 KB Posted
- Solicitation number
- 1202SA26B9400
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Airplane Pilot Qualifications and Approval Record form used to document and verify pilot credentials for federal aviation contracts, specifically for USFS (United States Forest Service) operations.
The form captures comprehensive pilot information including personal details, employment history, medical certification, and airman certificates (ATP, Commercial, Instrument, Type Ratings, etc.). It requires documentation of flying hours across multiple categories: total pilot time, pilot-in-command (PIC) time, cross-country hours, night operations, instrument flying (both total and actual), and specialized operations such as mountainous terrain flying. The form mandates FAA flight checks covering the specific types of operations required by the contract, with checkboxes for VFR, IFR, and IFR with autopilot qualifications. Additionally, it requests verification of previous agency approvals, any aircraft accidents or FAA violations within the past five years, and special mission operations conducted within the last 24 months. The vendor pilot card section allows selection of specialized mission types including ski operations, remote water operations, backcountry airstrip operations, fire detection, aerial photography, infrared mapping, and various mission classifications (1-7). Required supporting documentation includes pilot certificate, medical certificate, 12-month logbook, FAA Form 8410, A-110 HazMat training certification (if required), and a signed safety brief statement. The form concludes with pilot and chief pilot signatures certifying the accuracy of all information provided.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 1202SA26B9400 0001 NLFW MATOC.pdf | ||
| Exhibit 2 Vendor Information.pdf | ||
| Exhibit 1 SOI 27-29.xlsx | XLSX spreadsheet | |
| Attachment 7 Past Performance.pdf | ||
| Exhibit 7 Avionics.pdf | ||
| Exhibit 4 Weight and Balance.xlsx | XLSX spreadsheet | |
| E-11 52.212-3.pdf | ||
| Exhibit 6 Instructions.docx | DOCX document | |
| NLFW Exhibit 6 Rev 26ReOpen 05152026.xlsx | XLSX spreadsheet | |
| 1202SA26B9400 NLFW MATOC 2027 Reopen.pdf | ||
| SF 1449.pdf |
Show all 11
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
AIRPLANE PILOT QUALIFICATIONS AND APPROVAL RECORD
► S E C T I O N I – P I L O T I N F O R M A T I O N ( F i l l i n t h e b l a n k s ) ◄
1. Name (Last, First, Middle Initial) 2. Email Address 3. Telephone No.
4. Home Address (Street, City, State & Zip Code)
5. Employed by 6. Address 7. Telephone No. 8. Employed since
9. Previous Employer 10. Address 11. Telephone No. 12. Period Employed
13. Previous Employer 14. Address 15. Telephone No. 16. Period Employed
17. Medical Certificate
a. Class
b. Date
18. Airman Certificate (Check all that apply)
b. ATP e. Com h. Instrument
c. SEL f. MEL i. SES
d. MES g. CFI j. Type Ratings
19. A/C to be Flown
Flight Type Hours FAA FLIGHT CHECKS Date Make/Model A/C VFR IFR IFR W/AP
20. Total Pilot Time (Airplane) 35.
21. Pilot-in-Command (PIC) Airplane 36.
22. Total X-Country 37.
23. PIC Total Night 38.
24. PIC Instrument: Total Note: FAA Flight Checks Must Cover Type of Operations Required By Contract.
25. PIC Instrument: Actual
a. OAS
27. PIC Airplane: Mountainous Terrain
No Yes 42. Previous OAS or USFS Approval Denied, Suspended, or Revoked:
(If yes, Attach Date and Explanation)
28.
43. PIC "USFS Special Mission” Operations in the Last 24 Months:
33. PIC, Single Engine Airplane Land
Sea
34. PIC, Multi-Engine Airplane Land
Sea 45. Date
VENDOR PILOT CARD INFORMATION (Vendors select appropriate Special Use Mission(s)) A/C and IFR Quals Desired Ski Operations
Fire Detection
SEL IFR W/SIC
Remote Water Operations Infrared Mapping SES IFR, Single Pilot Backcountry Airstrip Aerial Photography MEL Single Engine IFR Unprepared Landing Site
Sketch Mapping
MES
Resource Reconnaissance Air Tactical
USFS Contract No(s):
Light Fixed-Wing Checklist. (Please provide copies of the following)
1. Pilot Certificate
2. Pilot Medical
3. Logbook (Last 12 months)
4. 8410(135.293, 135.297 if req’d & 135.299)
5. A-110 HazMat Training (if req'd)
6. Signed Safety Brief Statement
Additional Requested Documents:
Yes (If yes, Attach Date 41. Aircraft Accidents/FAA Violations Filed Within Last 5 Years: No and explanation)
Total PIC PIC last 12 Mo.
1. ___________ ________ _______
2. ___________ ________ _______
3. ___________ ________ _______
a. OAS
a. Number________________________
40. Date of Last Agency Flight Check39. Date of Previous Agency Card Approval
b. USFS b. USFS
I certify that the information listed on this form is true and correct.
44. Signature (Pilot)
Signature:(Chief Pilot)
Other IAA
26. PIC Airplane: Last 12 Months
29.
30.
31.
32.
Radio Telemetry
Float/Amphib
Law Enforcement Mountainous Terrain Point To Point
Mission 1, 2A & 2B
Mission 4A, 4B & 4C Mission 7
Mission 3A & 3B
Night
EXHIBIT 5 - AIRPLANE PILOT QUALIFICATIONS RECORD
SECTION D
EXHIBITS AND ATTACHMENTS
pdmcdonald Highlight mamorris Pencil mamorris Line
| 1 Name Last First Middle Initial: |
| 3 Telephone No: |
| 4 Home Address Street City State Zip Code: |
| 5 Employed by: |
| 6 Address: |
| 7 Telephone No: |
| 8 Employed since: |
| 9 Previous Employer: |
| 10 Address: |
| 11 Telephone No: |
| 12 Period Employed: |
| 13 Previous Employer: |
| 14 Address: |
| 15 Telephone No: |
| 16 Period Employed: |
| Hours21 PilotinCommand PIC Airplane: |
| Hours22 Total XCountry: |
| Hours23 Total Night: |
| Hours24 Instrument In Flight: |
| Hours25 Instrument Actual: |
| Hours26 Instrument Simulated: |
| Hours27 PIC Airplane Last 12 Months: |
| Hours28 PIC Airplane Last 60 Days: |
| Hours29 PIC Low Level Opns 500 AGL: |
| Hours30 PIC Mountainous Terrain: |
| 42 Previous OAS or USFS Approval Denied Suspended or No Yes Revoked If yes Attach Date and Explanation: |
| Hours31 PIC Aircraft over 12500 Gr Wt: |
| 43 PIC Air Tactical Operations Number of Missions in the Last 24 Months: |
| Hours32 PIC AirtankerDispensing Operations: |
| HoursLand: |
| HoursSea: |
| HoursLand_2: |
| HoursSea_2: |
| Date18_af_date: |
| Date19_af_date: |
| Date20_af_date: |
| Date21_af_date: |
| Text22: |
| Text23: |
| Text24: |
| Text25: |
| Check Box26: Off |
| Check Box29: Off |
| Check Box32: Off |
| Check Box34: Off |
| Check Box35: Off |
| Check Box37: Off |
| Date38_af_date: |
| Date39_af_date: |
| Check Box43: Off |
| Check Box44: Off |
| Check Box45: Off |
| Check Box46: Off |
| Check Box50: Off |
| Check Box51: Off |
| Check Box53: Off |
| Check Box54: Off |
| Check Box55: Off |
| Check Box56: Off |
| Check Box48: Off |
| Check Box52: Off |
| Check Box47: Off |
| Check Box59: Off |
| Check Box61: Off |
| Check Box62: Off |
| Check Box63: Off |
| Check Box64: Off |
| Text65: |
| Check Box66: Off |
| Check Box67: Off |
| Check Box68: Off |
| Check Box69: Off |
| Check Box71: Off |
| Check Box72: Off |
| Check Box73: Off |
| Text93: |
| Date94_af_date: |
| Date100_af_date: |
| Date10_af_date: |
| Date11_af_date: |
| Check Box28: Off |
| Check Box31: Off |
| Check Box27: Off |
| Check Box30: Off |
| Check Box33: Off |
| Check Box36: Off |
| Medical class: |
| Medical Date: |
| Certificate Number: |
| ATP: Off |
| SEL: Off |
| MES: Off |
| COM: Off |
| MEL: Off |
| CFI: Off |
| Instrument: Off |
| SES: Off |
| Type Ratings: |
| AC to be flown 1: |
| AC to be flown 2: |
| AC to be flown 3: |
| total PIC 1: |
| Total PIC 2: |
| Total PIC 3: |
| Total PIC in 12 2: |
| Total PIC in 12 3: |
| Total PIC in 12 1: |
| Total Time: |
| Text2: |
| Check Box70: Off |
| Check Box60: Off |
| Check Box57: Off |
| Check Box4: Off |
| Check Box1: Off |
| Check Box2: Off |
| Check Box3: Off |
| Check Box5: Off |
| Check Box6: Off |
| Check Box7: Off |
| Text8: |
| Text9: |
File details come from the government source that posted it. Updated .