The file's text, extracted by GovTribe without its formatting.
1. Name of Pilot (Last, First, MI) PA Dept. of Conservation & Natural Resources
| 2. Mailing Address |
| Bureau of Forestry |
| 3. City, State, Zip |
| Pilot Approval Form |
| 4. Home Phone |
| 5. Age |
| 6. Marital Status |
7. In the Event of an Emergency Notify:
| A. Name |
| B. Street Address, City, State |
| C. Phone |
| D. Relationship |
8. Employer Information
| A. Name of Employer |
| B. Employment Terms (Fulltime, Year Long, Seasonal, etc.) |
9. Airman Certification Information
| A. Type |
| B. Check All Appropriate |
| C. Certificate Number |
| D. Instrument Rating |
| E. Ratings (include Type Ratings if applicable) |
| F. Last BFR Date |
| G. Last Instrument Comp Check |
| H. Medical Class |
| I. Issue Date |
| J. Limitations to Airman Certificate or Medical |
| 10. Flight Hour Information |
| 11. Air Tanker Flight Hour Information |
| . |
| Total |
| Multi Engine |
| Past 12 Months |
| A. Pilot |
| Hrs |
| Hrs |
| Hrs |
| Approval Applied for |
| Total Hours |
| Hours Last 30 Days |
| B. Cross Country |
| Hrs |
| Hrs |
| Hrs |
| D. Instrument & Hood |
| Hrs |
| Hrs |
| Hrs |
| E. In Type to be Flown |
| Hrs |
| Hrs |
| Hrs |
F. Typical PA Terrain Flying Total Hours:
| 12. Last Approvals Issues (Interagency Carding, etc.) |
| G. Experience from Designated Base, Number of Seasons: |
| Attach/Scan a Copy of Interagency Card To/With This Form. |
13. Related Schools Attended Last 5 Years (Forest Service or Other)
14. Any Previous Approval Denied, Suspended, or Revoked? If Yes, Explain:
Certify that the Statements Made Hereon are True.
| 15. Signature of Applicant: |
| Date: |
| Attested to by Employer (Signature Required) |
| Date |
1 Jan 2009 Edition
BoF Pilot Approval Form 09
THIS FORM MUST BE SIGNED BY A REPRESNTATIVE OF THE EMPLOYER TO BE ACCEPTED.
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