Get AMD-64B/USFS 5700 2006-2024

In addition I certify that I have read the statement on the back of this form covering information pursuant to Public law 93-579 Privacy Act of 1974. Signature of Pilot Duty Approved For Inspectors Shall Initial For Inspector s Use Only Sling Operations 1 Wild Fowl Hazing 6B Hoversite 9C Fire Suppression/Helitack 2A Reconnaissance/Surveillance 6D Rappel 9D Helitanker/Bucket 2B Platform Landing Offshore 7 Instrument 11 Snow Operations Deep Snow 4 Helitorch/Aerial Ignition 8 Long Line--Remote Hook 12 Float Operations Fixed Flt 5 Mountain Flying 9A Night Vision Goggles 13 Animal Herding 6A USGS/BOM Special Experience 9B Other Type Aircraft Approved Inspector s Signature Agency Expiration Date Remarks AMD-64B/USFS 5700 10/06 White-Contracting/Tech. Services Yellow-Inspector Green-Pilot STATEMENT OF COMPETENCY has successfully completed the following proficiency Pilot Name checks and meets all FAR 135 requirements for this company 135. No Yes Explain Below Night PIC Offshore PIC Make/Model/Series Total Time PIC Time Last 12 mos. PIC Time Last 60 Days PIC Mountain Terrain PIC I certify that the information listed on this form is true and correct. In addition I certify that I have read the statement on the back of this form covering information pursuant to Public law 93-579 Privacy Act of 1974. Signature of Pilot Duty Approved For Inspectors Shall Initial For Inspector s Use Only Sling Operations 1 Wild Fowl Hazing 6B Hoversite 9C Fire Suppression/Helitack 2A Reconnaissance/Surveillance 6D Rappel 9D Helitanker/Bucket 2B Platform Landing Offshore 7 Instrument 11 Snow Operations Deep Snow 4 Helitorch/Aerial Ignition 8 Long Line--Remote Hook 12 Float Operations Fixed Flt 5 Mountain Flying 9A Night Vision Goggles 13 Animal Herding 6A USGS/BOM Special Experience 9B Other Type Aircraft Approved Inspector s Signature Agency Expiration Date Remarks AMD-64B/USFS 5700 10/06 White-Contracting/Tech. Signature of Pilot Duty Approved For Inspectors Shall Initial For Inspector s Use Only Sling Operations 1 Wild Fowl Hazing 6B Hoversite 9C Fire Suppression/Helitack 2A Reconnaissance/Surveillance 6D Rappel 9D Helitanker/Bucket 2B Platform Landing Offshore 7 Instrument 11 Snow Operations Deep Snow 4 Helitorch/Aerial Ignition 8 Long Line--Remote Hook 12 Float Operations Fixed Flt 5 Mountain Flying 9A Night Vision Goggles 13 Animal Herding 6A USGS/BOM Special Experience 9B Other Type Aircraft Approved Inspector s Signature Agency Expiration Date Remarks AMD-64B/USFS 5700 10/06 White-Contracting/Tech. Services Yellow-Inspector Green-Pilot STATEMENT OF COMPETENCY has successfully completed the following proficiency Pilot Name checks and meets all FAR 135 requirements for this company 135. 293 a b HELICOPTER Check Pilot FAA Office or Company Line/Route Check 135. 299 Type A/C Single Pilot IFR with Autopilot 135. Aviation Management Contract No. Rental Agreement No. INTERAGENCY HELICOPTER PILOT QUALIFICATIONS AND APPROVAL RECORD Name First Last MI Date of Birth Home Telephone Home Address City State Zip Code Employed By Address Employed Since Previous Employer Period Employed Airman Certificate Medical Certificate Class Date Date Last AMD/USFS Card Approval Number Limitations ATP COM Ratings Inspector s Name FAR 135 Flight Check Attach copies or complete statement on reverse Hours Pilot-In-Command Helicopter Turbine Engine Reciprocating Engine Last 12 Months Weight Class under 6 000 over 6 000 If AMD. USFS card has ever been denied suspended or revoked explain below. Aircraft Accident/FAA Violations filed within the last 5 Years. No Yes Explain Below Night PIC Offshore PIC Make/Model/Series Total Time PIC Time Last 12 mos. PIC Time Last 60 Days PIC Mountain Terrain PIC I certify that the information listed on this form is true and correct. .