BPM007303__Attachment_11__Airplane_Pilot_Qualifications_and_Approval_Record.pdf
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- Solicitation number
- BPM007303
- Issued by
- Arizona
About this file
This document is an Airplane Pilot Qualifications and Approval Record (Form FS-5700-0020) used by the United States Forest Service (USFS) and other federal agencies to evaluate and certify pilots for aerial operations. The form serves as the primary qualification and approval mechanism for pilots operating aircraft in support of forest management, firefighting, and emergency services missions. The form captures comprehensive pilot information including personal details, employment history, medical certification status, and detailed flight experience across multiple aircraft types and operational categories. Section I collects pilot background information and documents total pilot time in airplanes, pilot-in-command hours, cross-country experience, night flying hours, instrument proficiency ratings, and specialized experience in low-level operations, mountainous terrain operations, airtanker/dispensing operations, and unprepared landing site operations. The approval process requires inspection and certification by authorized USFS or Office of Aircraft Services (OAS) inspectors who must initial specific mission categories for which the pilot is approved.
Section II of the form designates inspector-use-only areas where specific missions are approved and documented, including ski operations, reconnaissance, airtanker pilot duties, lead plane operations, mountainous terrain flying, remote water operations, air tactical assignments, low-level operations, back country operations, airstrip sketching, mapping, smokejumper support, and other specialized functions. The inspector must verify FAA flight checks covering required operational types, document previous agency approvals or denials, and confirm no aircraft accidents or FAA violations have occurred within the preceding five years. For airtanker operations specifically, the form requires documentation of recent instrument proficiency checks, currency in type-rated aircraft, and takeoff/landing experience within the preceding 90 days. Pilot certification is valid for a specified term with an expiration date issued by the approving inspector, and pilots must sign certifications confirming the accuracy of provided information in compliance with Privacy Act requirements.
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Text version
FS-5700-0020 (03/2019)
OMB 0596-0015 (Omission of Exp. Date approved by OMB)
AIRPLANE PILOT QUALIFICATIONS AND APPROVAL RECORD
(Reference FSH 5709.16)
► 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
1. Name (Last, First, Middle Initial) 2. Date of Birth
4. Home Address (Street, City, State & Zip Code)
5. Employed by
9. Previous Employer
13. Previous Employer
17. Medical Certificate
a. Class _______________________
b. Date _______________________
Flight Type
20. Total Pilot Time (Airplane)
21. Pilot-in-Command (PIC) Airplane
22. Total X-Country
23. Total Night
24. Instrument: In Flight
25. Instrument: Actual
26. Instrument: Simulated
27. PIC Airplane: Last 12 Months
28. PIC Airplane: Last 60 Days
29. PIC “Low Level” Opns (-500 AGL)
30. PIC “Mountainous Terrain”
31. PIC Aircraft over 12,500 # Gr. Wt.
32. PIC Airtanker/Dispensing Operations
Land
33. PIC, Single Engine Airplane
Sea
Land
34. PIC, Multi-Engine Airplane
Sea
► S E C T I O N I I – F o r I n s p e c t o r s U s e O n l y ( I n i t i a l a p p r o p r i a t e M i s s i o n s ) ◄
1. Missions Approved For: (Inspector shall initial) Ski Operations Recon Airtanker Pilot (AKC/AKP/AKI/AKTP) Leadplane Mountainous Terrain
Remote Water Operations Air Tactical A rta nker (PIC/SIC) i Point to Point Low Level
Back Country Airstrip Sketch Mapping Smokejumper (PIC/SIC) Limitations
Unprepared Landing Site Infrared Operations Seat Pilot Level (1/2) Other
Paracargo Other
6. Address
10. Address
14. Address
18. Airman Certificate (Check all that apply)
a. Number _ ________________________________
b. ATP
e. SEL
h. MES
Hours
c. Com d. Instrument
f. MEL g. SES
i. CFI j. Type Ratings ______________________________ i n t h e b l a n k s ) ◄
3. Telephone No.
7. Telephone No. 8. Employed since
11. Telephone No. 12. Period Employed
15. Telephone No. 16. Period Employed
19. Aircraft To Be flown Total PIC Hours
(a) (b)
1. ______________ _______________
2. ______________ _______________
3. ______________ _______________
FAA FLIGHT CHECKS
Date Make/Model A/C VFR IFR IFR W/AP
35.
36.
37.
38.
Note: FAA Flight Checks Must Cover Type of Operations Required By Contract.
39. Date of Previous Agency Card Approval 40. Date of Last Agency Flight Check
a. OAS_________ b. USFS_________ a. OAS_________ b. USFS _________
41. Aircraft Accidents/FAA Violations Filed Within Last 5 Years: No Yes (If yes, Attach Date and Explanation)
42. Previous OAS or USFS Approval Denied, Suspended, or No Yes Revoked: (If yes, Attach Date and Explanation)
43. PIC “Air Tactical” Operations: Number of Missions in the Last 24 Months: ______________
44. Airtanker Operations Only:
a. Date Last PIC IFR Check in Type ___________ b. Date Last FAR 61.55 SIC Check
c. No. of Takeoff/Landings Last 90 Days ________ d. No. of Night Takeoff/Landings Last 90 Days _______
I certify that the information listed on this form is true and correct. In addition, I certify that I have read the statements on the back of this form covering information pursuant to Public Law 93-579 (Privacy Act of 1974) and any amendment thereto.
45. Signature (Pilot) 46. Date
2. SEL _____ ____ 3. SES ________ 4. MEL _________ 5. MES ___________ 6. IFR, W/SIC __________ 7. IFR, Single Pilot __________ 8. Single Engine IFR _________
9. Type Aircraft Approved For:
10. Print Name (Inspector) 11. Signature (Inspector) 12. Agency 13. Issue Date 14. Expiration Date
15. Aircraft/Contract Rental Agreement No(s).
Attachment 11: Airplane Pilot Qualifications and Approval Record
FS-5700-0020 (03/2019)
OMB 0596-0015 (Omission of Exp. Date approved by OMB)
16. Remarks (Limit 7,000 charecters)
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