LEADING EDGE INTERNATIONAL AVIATION ACADEMY, INC.

MAIN OFFICE, SAN FERNANDO CITY:

SAN FERNANDO AIRPORT, PORO POINT FREEPORT ZONE,
SAN FERNANDO CITY, LA UNION 2500 TEL: (072) 607-5868 CP: 0917-539-2578
EXTENSION OFFICE, TAGUIG CITY:
BGEN FELIX T. PESTANA (RET) BLDG., BLOCK 2 LOT 15,
DIEGO SILANG STREET, PHASE 1, AFPOVAI, WESTERN BICUTAN, TAGUIG CITY 1630
TEL: (02) 403-3593 CP: 0917-539-2577 mail@leadingedge.com.ph

REGISTRATION FORM
PERSONAL INFORMATION

Name: _____________________________________________________________________________________ 2x2

(Surname) (Given Name) (Middle Name) (Nickname) PICTURE

Pilot Course: _________________________________________ Starting Date: __________________________

Permanent Address: _________________________________________________________________

(House number) (Street)

_____________________________________________________________________________________________________
(City) (Country) (Postal Code)

Telephone: _________________________ Mobile Phone: __________________________________

Date of Birth: _______________________ Place of Birth: ___________________________________

(MM/DD/YY)

Philippine Address: _____________________________________________________________________________________

(House number) (Street)

_____________________________________________________________________________________________________
(City) (Country) (Postal Code)

Nationality: ____________________________________ Religion: ___________________________________________

Passport Number: _______________________________ Place of Issue: _______________________________________

Date Issued: ____________________________________ Expiry Date: _________________________________________

Primary E-mail Address: ______________________________________________________

Civil Status: ____________________________________ Age: ____________________

If married, name of spouse: ______________________________________________________________________________

(Surname) (Given Name) (Middle Name)

Height: ________________________ Weight: _________________________ Color of Eyes: _________________________

Color of Hair: ___________________ Complexion: ______________________ Built: _______________________________

Other Distinguishing Features: __________________________________________________________________________

Parents: Father’s Name: ____________________________________________

Mother’s Name: ____________________________________________

Address: ____________________________________________________________________________

Person to be contacted in case of emergency _____________________________________________________________

Address: ___________________________________________________________________________________________

Telephone: _________________________ Mobile Phone: __________________________________

 LEADING EDGE INTERNATIONAL AVIATION ACADEMY, INC.
MAIN OFFICE, SAN FERNANDO CITY:
SAN FERNANDO AIRPORT, PORO POINT FREEPORT ZONE,
SAN FERNANDO CITY, LA UNION 2500 TEL: (072) 607-5868 CP: 0917-539-2578
EXTENSION OFFICE, TAGUIG CITY:
BGEN FELIX T. PESTANA (RET) BLDG., BLOCK 2 LOT 15,
DIEGO SILANG STREET, PHASE 1, AFPOVAI, WESTERN BICUTAN, TAGUIG CITY 1630
TEL: (02) 403-3593 CP: 0917-539-2577 mail@leadingedge.com.ph

EDUCATIONAL BACKGROUND

School / Address Year Course Finished

Elementary: _______________________________________ ______________ ________________________

High School: _______________________________________ _______________ ________________________

College: _______________________________________ _______________ _________________________

FLIGHT EXPERIENCE

Do you hold a pilot’s License/s? YES ____________ NO ____________

NAME OF FLYING SCHOOL ADDRESS COURSE FINISHED YEAR

________________________ ________________________ _______________________ __________

________________________ ________________________ _______________________ __________

TOTAL FLYING TIME: _________________________hours

License: ___________________________________

PEL Number: _______________________________ Issued by: ____________________________

Aircraft Rating: _____________________________

Latest Airman Medical Certificate: Class: _____________ Issued by: ____________________________

Date Issued: ____________________________________ Date Expired: __________________________

EMPLOYMENT

Are you currently employed? YES ____________ NO ____________ If yes, please complete below:

Employer’s Name: _________________________________________________________________________________

Employer’s Address: _______________________________________________________________________________

Employer’s Contact No.: __________________________________ Job Title: _______________________________

Supervisor: ____________________________________________ Date of Employment: _____________________

I hereby certify to the correctness of the foregoing facts:

_______________________________________________
(Applicant’s Signature)

How did you hear about us?

____Internet (Website)
____Friends/ Family ______________
____School
____Posters/Brochures/flyers
____Others