FLIGHT CREW TRAINING

Request for recurrent training and or recurrent checking

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D13013180

STEP 1. REQUESTED COURSE(S) – to be completed by the Operator Representative

OPERATOR ICAO Code:
Aircraft Type: A320 A330
Applicant Position: CAPTAIN
System knowledge
Simulator training
Simulator checking
Reporting forms
Clear Form
Training starting date: Location of training: To be defined
A340 A350 A380 A310/A300
F/O
Sys. review required: NO YES
Sys. test required: NO YES
NO simulator training required
Recurrent training syllabus Airbus FCTP training syllabus cycle A B C D E
Operator training syllabus Ref: Number of FFS training sessions:
Instructor required SFI TRI (mandatory if LVO or ETOPS included in training syllabus)
Type of check required LPC only OPC only LPC and OPC NO simulator check required
Airbus FCTP check syllabus cycle A B C D E
Check syllabus
Operator checking syllabus
Any Airbus examiner
TREs approved for OPC
Airbus examiners on attached list
Airbus reporting forms
Operator reporting forms
Send to applicant(s)

STEP 2. APPLICANT INFORMATION

2.1 IDENTITY
Family Name: Wesley Pereira Goncalves First Name: Leudson Gender: Male Female
Date of Birth: 24/09/1984 Place of Birth: Sao Paulo Nationality: Brazilian
Passport Number: FK594666 Place of Issue: Sao Paulo Expiry Date: 27/07/2019
2.2 LICENSE TO BE ENDORSED / RATINGS & CERTIFICATES
Number: 12945 ATPL CPL
License
State: JAA/EASA FAA OTHER
Rating to be
Expiry Date: Date of Last Proficiency Check: 01/04/18
revalidated

2.3 FLIGHT EXPERIENCE ON TYPE (all excluding FSTD)

Total Flight hours on type: 4286 Date of Last Flight on type: 09/02/17
Flight hours on type in the last 12 months: 439 Sectors flown on type in the last 12 months: 0
Additional information (any information relevant for the intended training may be added here)

2.4 APPLICANT VALIDATION To be signed by the Applicant at beginning of the training.

Family Name: Wesley Pereira Goncalves I certify that the above statement is true and accurate.
First Name: Leudson Date: Signature: Send to training manager

STEP 3. OPERATOR REPRESENTATIVE VALIDATION

Family Name: I have checked and I confirm that all the information on this form is true and
accurate.
Job title: Validate and send to Airbus
Email: Date: 19/04/2018 Signature:

AIRBUS Internal Use

Received date:

Remarks:

Checked by: Date:

Information collected will be stored for flight training purposes. In accordance with French Law 78-17, January 6, 1978, the Applicant has the right of opposition, access and correction of the information.
The Applicant may exercise this right by sending a request to Airbus Training Centre, 1 Rond-Point Maurice Bellonte, 31707, Blagnac, France.
Page 1 of 1 FM_______ V1.0.0
Date: July the 20th, 2014