Application Form – PILOTS
  Personal Information
* Name :
First Name Middle Name Last Name
*Date Of Birth :
* Nationality :
Country Of Residence :
* Tel ( Home ) :
*Mobile No :
* Gender :
Male Female *Marital Status : Married Unmarried
*Address(Present) :
*Address(Permanent) :
*Personal Email :
Medical : Do you have any medical condition that UHPL Should be aware of ?
    Yes  No  if yes, Specify Details :
    Were you anytime medically grounded ?
    Yes  No  if yes, Specify Details :
Languages
 
Language Known
READ
WRITE
SPEAK
 
BA
A
AA
 BA
A
AA
 BA
A
AA
1.
2.
3.
4.
 
BA - BELOW AVERAGE A - AVERAGE AA - ABOVE AVERAGE
  Employment Information
*Position Applied For ? :
Have you applied before (Yes/No) ? :
Yes  No   if yes,
Have you work with us before(Yes/No) ? :
Yes  No if yes,
Please specify Job Reference No. :
*Earliest Availability :(specify period / date) :
Required Notice Period to Current Employer :
Yes  No  
If Yes, Provide details
(Month/Days)		 :
Current CTC Monthly/Yearly  (USD/INR) :
 INR  USD
Expected CTC Monthly/Yearly  (USD/INR) :
 INR  USD

  Family Members (List down the names of your spouse, children)
No
Name
DOB
Relationship
 Current Status
Working/Not Working/ Student
1.
2.
3.
4.

 Acdemic Qualification
School, College & University Certificates & Degrees
(SSC/HSC/CPL/CHPL/GRADUATE/POST GRADUATE, ETC)		 Year Of Passing
 Additional Qualification
School, College & University Certificates & Degrees Year Of Passing

  Course Information
Helicopter Underwater Escape Training : if Yes, Provider & Location : Date :
Crew Resources Management : if Yes, Provider & Location : Date :
Dangerous Goods Awareness : if Yes, Provider & Location : Date :
Fire Fighting : if Yes, Provider & Location : Date :
First Aid : if Yes, Provider & Location : Date :
H2S : if Yes, Provider & Location : Date :
Other : if Yes, Provider & Location : Date :
Other : if Yes, Provider & Location : Date :
  License & Medical Details
Type of License
License Issuing Authority
    License Number/Validity A/C By Types
Whether Commercial Instrument Rating Held ? : Yes  No  
Class-1 Medical Certificate Expiry :
Any Restrictions :
Yes  No   If Yes, Please Specify details :
Have you ever had a License or Medical application declined or suspended :
Yes  No   If Yes, Please Specify details :

  Hours Summary
Total Hours Fixed Wing : Total P1 : Total P2 :
Total Hours Helicopter : Total P1 : Total P2 :
Total Hours Helicopter Night :
Total Hours Instrument :
Do you have any experience of offshore flying  directly in support of the Oil or Gas Industry ? :
Yes  No If yes :
Do you have any experience of offshore flying? :
Total Hours Under slung :
Total Hours Long Line :
Total Hours Mountain :
Total Hours Twin Engine In Command / PICUS :
Total hours Last 3 Months :
Total EMS Experience :
Total hours Last 12 Months :
Total EMS Experience :
Other :

  Aircraft Type
 Bell 212
            
Last Date of Simulator Training
 :        
P1
 :
P2: Date Last Flown:
 Bell 412            
Last Date of Simulator Training
 :        
P1
:
P2: Date Last Flown:
 AUGUSTA AW139            
Last Date of Simulator Training
 :        
P1
:
P2: Date Last Flown:
 ALH (DHRUV)            
Last Date of Simulator Training
 :        
P1
:
P2: Date Last Flown:
  Other Type
Type
P1
P2
Date Last Flown    
  Helicopter Role Experience
             A/C Types       Hours Flown          Location
Instrument Flying (Military) :
Instrument Flying (Civil) :
Load Lifting :
Winching :
Mountain (Above 3000’) :
Desert :
Jungle :
Offshore :
Crop Spraying / Pest Control :
EMS :
VIP :
Any Other :
Any Other :
Provide details of any incident /Accident that has resulted in suspension or loss of license, or resulted in Termination of An Employment Contract.
Any other Aviation Experience / Qualification (Fixed Wing Etc)
  Employment History
Current Employer’s
Name		 Location of Work Date Salary/Month
(USD/INR)		 Position A/C Type Worked
on
    From To      
  Previous Employment Details
Previous Employer’s
Name		 Location of Work Date Salary/Month
(USD/INR)		 Position A/C Type Worked
on
    From To      
Have you ever been involved in an Aircraft
Accident ? 		 
Yes  No If Yes, Please Specify details :
Have you been associated with / or member
of any Trade Union / Labour Union / Political
Party etc?		  
Yes  No If Yes, Please Specify details :
Are you associate with / or member of any
Trade Union / Labour Union / Political Party
etc.?		  
Yes  No If Yes, Please Specify details :
Have you been convicted either in India or
Abroad for any act as per various provisions
of law ? 		 
Yes  No If Yes, Please Specify details :
Is / Are there any litigation / cases pending
against you (Civil / Criminal / Family )?		  
Yes  No If Yes, Please Specify details :
SPARE TIME ACTIVITIES AND / OR INTERESTS
Please give details:
  Work References
Please list upto two references whom UHPL may contact, regarding your current and previous employment.
Name
Company
Business Phone No.
(include Area code)
  Position   
Other relevant information / Any other important point / information which you may like to reveal i.e. outstanding award / reward for performance etc.:
Declaration
By submitting the above information you confirm that the information given is correct and any incorrect information will adversely affect your eligibility for employment. or liable for termination of services if employed.

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