Norwegian flight deck candidate questionnaire and declaration

Thank you for your application as a flight crew member with Norwegian based in Argentina. We look forward to
supporting you with your application for assignment to Norwegian.

This document is required to be completed as part of the application process to ensure that we fully understand
your current employment situation, background and experience. Please do not hesitate to contact us at any time.

Please fill in the form on a computer, print, sign on the last page, scan as a pdf and return via email.

Note: Some questions below could be answered “No”. If “No” is your answer, please type it into the relevant box.

Note: If successful in the screening process, a thorough background, documents and references checks will be
conducted. Therefore, it is important that you are open, honest and accurate when filling in this form. If it is later
discovered that relevant information was omitted, or the information provided is incorrect, the offer of
employment or any contract entered into with you may be rescinded.

1. General information

1.1 Applicant’s name and date of birth.

Volpi Sergio Arturo 01/12/1986

Surname First name (s) Date of birth (DD/MM/YYYY)

1.2 Position/s applied for. Please tick only a position that you fulfill the minimum requirements for.

☐ First Officer

☒ Captain

2. Current employer, certain background and experience

2.1 Current or last (as applicable) employer airline and position (rank) held.

Andes Lineas Aereas, PIC 737NG

2.2 Date of last flight and on what aircraft type.

22/06/2018 737NG

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 2.3 Total flight hours. For type less than 5,700 kg / 12,500 lb, please do not divide into different types. For
types above 5,700 kg / 12,500 lb, please list each type. Flight hours should be listed as logged according the
regulations of the CAA the operator is authorized by. Simulator hours shall not be included. Add rows if
needed.

PIC hours Widebody EFIS equipped

Airline Aircraft type Flight hours
(no PICUS) hours hours

Total flight Total PIC Total

Total EFIS
Totals hours hours widebody

2.4 Please indicate which of the following experiences you have (tick the applicable boxes).

☐ ETOPS ☐ CPDLC

2.5 Do you have experience flying in any of the regions below (tick the applicable boxes)?

☐ Europe ☐ Africa ☐ Austral-Asia

☐ South America ☐ North America ☐ North Atlantic (NAT HLA/MNPS)

2.6 Please indicate how recent since you operated on a regular basis in a long haul operation, typically
oceanic crossings or intercontinental flights such as from Europe to Far East or Sub-Sahara (tick the
applicable box).

☐ Within the last year ☐ Within the last 3 years ☐ Within the last 5 years

☐ More than 5 years ago ☐ Never

3. Flight crew license/certificate, medical and passport

3.1 Flight crew license/s or certificate/s and issuing state/s.

3.2 Expiry date of license/certificate.

3.3 Instrument rating expiry date.

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 3.4 Type rating/s and expiry date/s, issuing state for each rating, and if any restrictions.

3.5 Date of last simulator.

3.6 Have you ever functioned as a ground school instructor, SFI, line trainer, TRI or TRE, or been involved in
checking? If YES, which functions or positions have you had, on which aircraft type/s and with which
employer/s?

3.7 Medical/s and if any restriction (except correction lenses), and expiry date.

3.8a Issuing state of passport and passport number.

3.8b Document for permanent residency if non-Argentinian citizen.

4. Previous applications to Norwegian

4.1 Have you ever applied to Norwegian before (including through any agency)? If YES, please provide date
of application/s.

4.2 Have you ever screened/interviewed with Norwegian before (including through any agency)? If YES,
please provide date, location of screening and outcome.

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5. Medical, flying and criminal history

5.1 Have you ever had an aviation medical certificate denied, suspended or revoked by any licensing
authority? If YES, please provide details.

5.2 Do you currently have, or have you previously had, any medical or health concerns or conditions? If YES,
please provide details.

5.3 Have you ever had any form of surgery (including eye surgery)? If YES, please advise what type of surgery
you had, when you had that surgery and whether you have fully recovered.

5.4 Have you ever failed an assessment, training or check (screening, initial training, airline re-currency, been
denied upgrade or failed upgrade assessment, upgrade training or upgrade check, or else)? If YES, please
provide details.

5.5 Have you ever been downgraded from a higher rank (such as a captain position) due to performance, or
for any other reason? If YES, please provide details.

5.6 Have you ever been involved in any aviation related incidents or accidents or are you currently under
investigation for an aviation related incident or accident? If YES, please provide details.

5.7 Have you ever been dismissed, made redundant or asked to leave an airline, or not had your contract
extended or renewed by an airline or contracting party, or been the subject of an airline disciplinary review
or investigation, or have received a warning or warning letter, or similar? If YES, please provide details.

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 5.8 Have you ever resigned from an employer or ended a contract/assignment for other reasons than
advancing your career? If YES, please provide details.

5.9 Have you ever had a gap of three months or more in your work history? If YES, please provide details
why you had such gap and what you were doing during this time.

5.10 If appointed you will have to pass security checks. Possible Visa applications will also have to be made.
With these in mind, please indicate whether you have you ever been convicted of a criminal offence? If YES,
please provide details such as where, what the nature of the conviction was, when this was, and what
sentence that was imposed. If any criminal proceedings are pending or outstanding, please provide full
details.

6. Motivation

6.1 Please let us know why you are considering another airline at this time?

6.2 What would be the reason for leaving your present employer for Norwegian?

6.3 What period of notice are you required to provide your current employer?

6.4 Do you have any bonding or financial obligations to any previous or present employer. If YES, please
provide details.

6.5 If you are not currently flying, what was the reason for leaving your last airline employer?

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 6.6 If you are not currently flying, what have you been doing since your last flying job?

6.7 If accepted by Norwegian, are you able to commit to the terms of the contract? If NO, please explain.

7. Referee details

Please provide the contact details of at least two referees. If you have worked for more than one airline over
the last five years, please ensure that you provide at least one referee from each airline who can confirm
your employment, dates, hours at the airline, and that were your immediate supervisors (including your
current airline*) such as Director of Operations, Chief Pilot, Manager/Superior or Post Holder.

Please supply the airline’s flight operations office number or the office number of the location where the
referee is stationed, and the referee’s company email address.

1.

Name
Position
Company
Contact phone number
Contact email address

2.

Name
Position
Company
Contact phone number
Contact email address

3.

Name
Position
Company
Contact phone number
Contact email address

* Tick the below box if you do not wish us to contact your current airline/manager until a job offer has been
accepted by you. Please note that after a job offer has been accepted by you and prior to starting on
contract, Norwegian and/or any of its business partners will contact necessary persons to verify your flight
experience and background.

☐ I do not wish that my current airline/manager is contacted until a job offer has been accepted by me.
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8. Declaration and consent

I, the undersigned confirm and declare that

 All information provided by me in this questionnaire and any documentation I provide to Norwegian
and/or any of its business partners (provided so far and in the future) is complete and accurate and
I understand and acknowledge that any misrepresentation or falsification may lead to termination
of the application process or any agreement between myself and Norwegian and/or any of its
business partners; and
 I understand that Norwegian and/or any of its business partners will contact any of the referees
provided and will carry out checks in respect of any documentation or information provided
including contacting any airline or persons necessary to verify my experience, qualifications, records
or the information contained in my application, and I consent to all such checks and to the
disclosure of information provided in relation to my application.

_________________________ _________________________

Name Mobile telephone number

_________________________ _________________________

Signature Date

Thank you for taking time to complete this form.

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