16是否持有或曾经持有过
CAAC颁发的驾驶员执照？
Do you hold a CAAC Pilot License?
□是Yes□否No
17a执照编号License No.
17b FN编号FN Serial Number
18颁发日期Date of Issue
年Y月M日D
执照到期日期Date of Expiration
Small 2 inch
blue background
1姓名(汉语及全拼)Name
2国籍Nationality
3出生日期Date of Birth
年Y月M日D
4性别Sex
□男Male
□女Female
5出生地Place of Birth
6民族(中国籍)Chinese Only
7联系电话Telephone
22已持有哪国ICAO英语语言能力等级签注Which level and which County of ICAO English Proficiency Level do you hold?□是Yes颁发国Country等级Level□无No
23是否有处罚记录？Whetheryou havea record ofPenalty?
14学习简历
Education
起止年月Period
校、院、专业及取得的学位School, College, Major and Degree
15工作经历
Experience
起止年月Period
在何地、何部门、任何职务Location, Service Organization and Title
II申请信息Application Information
□运动教员等级SportInstructorRating
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□无ห้องสมุดไป่ตู้o
□有Yes
□行政处罚Administrative Penalty
□警告Warn□罚款Fine□暂扣Suspension□吊销Revocation
处罚日期Date of Penalty_____________________
□刑事处罚Criminal Penalty处罚日期Date of Penalty_________________
申请人签字Signature of Applicant
III基于下列哪一项目申请执照和等级License or Rating Applied for on Basis of
□A按61部完成训练和考试
Completion of
Training andTestaccording to CCAR-61
24b申请执照或等级ApplicationInformation
□运动驾驶员执照Sports PilotLicense
□私用驾驶员执照Private Pilot License
□商用驾驶员执照Commercial Pilot License
□多人制机组驾驶员执照Multi-Crew PilotLicense
□航线运输驾驶员执照Airline Transport Pilot License
□仪表等级Instrument Rating
□型别等级Type Rating
□基础教员等级FlightInstructorRating
□仪表教员等级Flight Instructor-InstrumentRating
□型别教员等级Type RatingInstructorRating
民用航空器驾驶员执照和等级申请表
Application for Civil Aircraft Pilot License and/or Rating
用墨水笔或打印填写所有项目Type or Print All Entries in Ink
I基本信息Basic Information
照片
Photo
(蓝底彩色小2寸)
8通讯地址Mailing Address
9邮政编码Zip Code
10工作单位Service Organization
11永久住址Permanent Residence Address
12身份证明名称Type of Identification Document
□身份证ID□其它Others
13身份证明编号Identification Document No.
说明Explanation_______________________________________________________________
24a申请执照或等级ApplicationInformation
□初次申请Initial Application□增加等级Additional Rating□执照更新Renewal
年Y月M日D
19持有CAAC颁发的有效的体检合格证等级□I□II□III□IV
Which class of the valid CAAC Medical Certificate do you hold?
20体检合格证有效期至__年___月___日
Date of ExpirationYMD
21你能正确读、听、说、写汉语吗？Can you read, hear, speak and write the Chinese language?□是Yes□否No
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声明：我保证上述填写内容属实，如有不实后果本人负责。
APPLICANT'S STATEMENT: I certify that all statements and answers provided by me on the application form are complete and true to the best of my knowledge.