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Pilot History

Name:
Address:
City:
State:
Zip:
Phone:
Email:
Date of Birth:

Certificate(s) held:
ATP COMM IFR CFI (Check all that apply)

Aircraft ratings held:
Total logged hours – all aircraft:
Total logged hours – retractable:
Total logged hours – multi-engine:
Total logged hours – turbo prop:
Instruction given:

Total make and model hours – (in applicable aircraft flown)
Aircraft Number of hours
1.
2.
3.
4.
5.
6.
7.
8.
9.

Any losses, waivers or violations? Yes No
If yes, please explain:

Have you attended Flight Safety/Simuflight? Yes No
If yes, when and what aircraft:

Do you attend Flight Safety or Simuflight recurrent training?
Annually Biannually

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