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#17-002281-0001
Supplemental Questionnaire

Last Name
First Name
1.

Indicate in the box below the total number of flight hours and the last date flown in the AW/139.

2.

Indicate in the box below the total number of flight hours and the last date flown in a multi-engine helicopter.

3.

Indicate in the box below the total number of flight hours and the last date flown in a turbine helicopter.

4.

Indicate in the box below the total number of flight hours and the last date flown in a piston helicopter.

5.

Please list the total hours of helicopter pilot flight time experience.

6.

How much of helicopter flight time experience is as Second-In-Command (SIC)?

7.

How much of the helicopter pilot flight time experience is as Pilot-In-Command (PIC)?

8.

How many helicopter flight hours do you possess in simulated (full motion or under the hood) instrument conditions?

9.

How many helicopter flight hours do you possess in actual instrument conditions?

10.

How much of your total helicopter pilot flight time was spent in a multi-pilot operating environment?

11.

Do you have work experience or possess training certification(s) in any of the following:

Emergency Medical Services, Search and Rescue or Law Enforcement missions as a member of a flight crew
Glass Cock-Pit Experience
Military or FAA Part 135 Experience
Night Vision Goggle Experience
Flight Management System Experience
Hoisting Experience
None of the above
12.

Do you possess any of the following Federal Aviation Administration certifications?

Certified Flight Instructor (CFI)
Certified Flight Instructor Instrument (CFII)
Airline Transport Pilot
None of the above
 

If certified, please list type of certification(s)


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