FLIGHT TIME RECORD

Instructions : List all flight hours on this form, do not refer us to your resume.
Do not count 50% rated F/O time as Captain time.
IP time refers to line and aircraft instructor time only (and not simulator time). Please note that total IP time will for m part of total flight time.
Aircraft Aircraft Flight Hours Qualifications
Classification (Enter nearest whole hour) Date Date Date
Designation Airline Military Captain First Officer Total Flight Total IP Type Check Aircraft Simulator *ROUTE ETOPS First Last Last
Name Branch or IP SIC Time Time Rating Airman Instructor Instructor FLOWN CATII/III Flown Flown P/C Check
or Dual
JET

Turboprop

**TRAINING (FLIGHT SCHOOL HOURS INCLUDED) EXPERIENCE BELOW:

(Please specify the Aircraft type and list hours on different models in separated column)

Date of last P/C check in a commercial aircraft： *Please indicate the following No. in the column.
Type aircraft / simulator 1. ASIA 7. MID. EAST DATE：
Date of last aircraft flight 2. EUROPE 8. DOMESTIC
FAR Part 121/141 hours : Last 3 months 3. PACIFIC / ATALANTIC NAME：
Last 6 months 4. N. AMERICA
Last year 5. S. AMERICA
Last 2 years 6. AFRICA SIGNATURE :
Total Commercial Jet (MOTW heavier than 40 tons) PIC hours in the last 2 years

WARNING : In accordance with Civil Aviation Law of the Republic of China article 82, any person who by fraudulence in application obtains airman license or certificate of rating, shall be liable to i/prisonment not exceeding five years,
detention or a fine from 10,000 to 50,000 yuan. This flight record will be submitted to C.A.A. for obtaining Taiwan certificate, so be sure all the time you put are authentic and correct./