place of birth: place of origin: nationality: initial skill test repetition of failed / partially passed skill test, from date:
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1 Frl Dprtmnt o th Environmnt, Trnsport, Enrgy n Communitions DETEC Frl Oi o Civil Avition FOCA Sty Division Flight Prsonnl 3003 Brn LAPL(A) Skill tst Applition n rport orm Applint lst nm: irst nm: t o irth: pl o irth: pl o origin: ntionlity: privt rss: post o: ity: strt: phon/x hom: phon/x oi: -mil: initil skill tst rptition o il / prtilly pss skill tst, rom t: onvrsion to n EASA lin LAPL(A) skill tst on TMG or holr o LAPL(S) with TMG Instrutor lst nm: irst nm: lin numr: signtur o light instrutor: Th ATO onirms tht th nit hs n trin oring to th pprov syllus n ssurs th lvl o proiiny rquir. ATO nm: rgistrtion numr: nm o hi light instrutor: lin numr: lotion & t: signtur o hi light instrutor: 1 Dtils o light t: typ o ropln: rgistrtion: lss: TR: prtur/stintion lok-o: lok-on: lok tim: # o lnings: 2 Rsult o skill tst *lt s nssry Applint's signtur pss* il* prtil pss* 3 Rmrks Exminr: lst nm: irst nm: xminr uthoristion: lin numr: lotion n t: signtur o light xminr: FOCA/EASA Form EASA AMC1 FCL.125 1/6
2 BAZL OFAC UFAC FOCA CH-3003 Brn (Switzrln) Instrution / xprin rport A opy o th rlvnt logook pgs (light xprin & STD pgs) showing th onirm ompltion o th light instrution must tth to this orm. Pls mk sur to mrk your lin numr togthr with your signtur t th ottom o th pgs. Summry o onitions n lying xprin or LAPL(A) skill tst ) Applints minimum g: 17 yrs ) Enlos opy o pssport ) EASA Mil lss 1 or 2 or LAPL vli until: ) Thortil xmintion PPL(A) pss t: ) VFR riotlphony prtil tst pss t: Lngug proiiny MNM lvl 4 i pplil vli until: ) Flight instrution (MNM 30 HR) hours: Holrs o LAPL(S) with TMG xtnsion shll hv omplt t lst 21 hours o light tim on TMGs tr th norsmnt o th TMG xtnsion n shll omply with th rquirmnts o FCL.135. A() on roplns hours g) Dul instrution (MNM 15 HR) hours: h) Solo instrution (MNM 6 HR) hours: o whih solo ross ountry (MNM 3 HR) hours: Lg 1 DEP DEST KM Lg 2 DEP DEST KM totl (MNM 150 Km grt irl istn) KM Aitionl trining or night quliition: i) Night light xprin (MNM 5 HR) hours: j) Dul instrution (MNM 3 HR) hours: inl. ul ross ountry nvigtion (MNM 1 HR) hours: Solo tk-os n lnings (MNM 5) tk-os: lnings: FOCA/EASA Form EASA AMC1 FCL.125 2/6
3 BAZL OFAC UFAC FOCA CH-3003 Brn (Switzrln) Conut o th skill tst An pplint shll pss ll pplil stions. I ny itm in stion is il, tht stion is il. Filur in mor thn on stion will rquir th pplint to tk th ntir tst gin. An pplint iling only on stion shll tk th il stion gin. Filur in ny stion o th r-tst, inluing thos stions tht hv n pss on prvious ttmpt, will rquir th pplint to tk th ntir tst gin. All stions o th skill tst shll omplt within six months. Furthr trining my rquir ollowing ny on il skill tst. Filur to hiv pss in ll stions o th tst in two ttmpts will rquir urthr trining s trmin y th Authority. Thr is no limit to th numr o skill tsts tht my ttmpt. Th Authority will provi th FE with qut sty vi to nsur tht th tst is onut sly. Shoul th pplint hoos to trmint skill tst or rsons onsir inqut y th FE, th pplint shll rtk th ntir skill tst. I th tst is trmint or rsons onsir qut y th FE, only thos stions not omplt shll tst in urthr light. Any mnouvr or prour o th tst my rpt on y th pplint. Th FE my stop th tst t ny stg i it is onsir tht th pplint's monstrtion o lying skills rquirs omplt r-tst. An pplint shll rquir to ly th ropln rom position whr th pilot-in-ommn untions n prorm n rry out th tst s i thr is no othr rw mmr. Rsponsiility or th light shll llot in orn with ntionl rgultions. Th rout to lown or th nvigtion tst shll hosn y th FE. Th rout my n t th rorom o prtur or t nothr rorom. Th pplint shll rsponsil or th light plnning n shll nsur tht ll quipmnt n oumnttion or th xution o th light r on or. An pplint shll init to th FE th hks n utis rri out, inluing th intiition o rio ilitis. Chks shll omplt in orn with th uthoris hk list or th ropln whih th tst is ing tkn. During pr-light prprtion or th tst th pplint is rquir to trmin powr sttings n sps. Prormn t or tk-o, pproh n lning shll lult y th pplint in omplin with th oprtions mnul or light mnul or th ropln us. Th FE will tk no prt in th oprtion o th ropln xpt whr intrvntion is nssry in th intrsts o sty or to voi unptl ly to othr tri. Hinwis: Innrt 10 Tgn nh Zustllung s Ergnisss s Skilltsts/Proiinyhks knn im Bunsmt ür Zivilluthrt, 3003 Brn, shritlih i Ausstllung inr shwrähign Vrügung ür s Prüungsrsultt vrlngt wrn. Rmrqu: Il st possil, ns ls ix jours suivnt l ommunition u résultt u Skill Tst/Proiiny Chk 'otnir, sur réquêt érit uprès l'oi éérl l'vition ivil, 3003 Brn, un éision susptil rours portnt sur l résultt uit xmn. Avviso: Entro ii giorni ll'invio i rsultti llo Skill Tst/Proiiny Chk può ssr rihist pr isritto ll'uiio rl ll'vizion ivil, 3003 Brn, un ision impugnil sull'sito ll'sm. Rmrk: Within 10 ys tr ript o this skill tst/proiiny hk rsult, n ppll ision out th tst / hk rsults my rqust in writing to th Frl Oi o Civil Avition, 3003 Brn, using on o th oiil lngugs (Grmn/Frnh/Itlin) FOCA/EASA Form EASA AMC1 FCL.125 3/6
4 BAZL OFAC UFAC FOCA CH-3003 Brn (Switzrln) Us o hklist, irmnship, A/C limittions must rspt in ll stions Stion 1 1 ttmpt 2 ttmpt pss il pss il Pr-light oprtions & prtur Pr-light oumnttion NOTAM n Wthr riing Mss & ln n prormn lultion Aropln insption & srviing Engin strting n tr strting prours Txiing & rorom prours, pr tk-o prours Tk-o n tr tk-o hks g Arorom prtur prours h ATC liison: omplin pls lt s nssry pss il xminr's signtur Stion 2 1 ttmpt 2 ttmpt pss il pss il Gnrl irwork ATC liison Stright n lvl light with sp hngs Climing: i. Bst rt o lim ii. Climing turns iii. Lvlling o Mium (30 nk) turns, look-out prours n ollision voin Stp (45 nk) turns g Flight t ritilly low irsp with n without lps Stlling: i. ln stll n rovr with powr ii. iii. Approh to stll in sning turn with nk ngl 20, pproh onigurtion Approh to stll in lning onigurtion h Dsning: i. With n without powr ii. Dsning turns (stp gliing turns) iii. Lvlling o pls lt s nssry pss il xminr's signtur FOCA/EASA Form EASA AMC1 FCL.125 4/6
5 BAZL OFAC UFAC FOCA CH-3003 Brn (Switzrln) Us o hklist, irmnship, A/C limittions must rspt in ll stions Stion 3 1 ttmpt 2 ttmpt pss il pss il En-rout Prours Flight pln, rkoning & mp ring Mintnn o ltitu, hing n sp Orinttion, timing n rvision o ETAs & log kping Divrsion to ltrnt rorom (plnning n implmnttion) Flight mngmnt (hks, ul systms & rurtor iing, t.) ATC liison: omplin pls lt s nssry pss il xminr's signtur Stion 4 1 ttmpt 2 ttmpt pss il pss il Approh n lning prours Arorom rrivl prour Collision voin (look-out prours) Prision lning (short il lning) n rosswin, i suitl onitions prviling Flplss lning (i pplil) Approh to lning with il powr Touh n go g Go-roun rom low hight h ATC liison i Ations tr light pls lt s nssry pss il xminr's signtur FOCA/EASA Form EASA AMC1 FCL.125 5/6
6 BAZL OFAC UFAC FOCA CH-3003 Brn (Switzrln) Us o hklist, irmnship, A/C limittions must rspt in ll stions Stion 5 Anorml & mrgny prours 1 ttmpt 2 ttmpt (This stion my omin with Stions 1 to 4) pss il pss il Simult ngin ilur tr tk-o * Simult or lning * Simult prutionry lning Simult mrgnis Orl qustions pls lt s nssry * this itms my omin t th isrtion o th FE pss il xminr's signtur By signing this orm, I lr: ) ) ) ) I o not possss pilot lin, rtiit, rting, uthoristion or ttsttion with th sm sop n in th sm tgory issu in nothr EASA Mmr Stt. I hv not ppli or pilot lin, rtiit, rting, uthoristion or ttsttion with th sm sop n in th sm tgory issu in nothr EASA Mmr Stt. I hv nvr possss ny prsonnl lin, rtiit, rting, uthoristion or ttsttion with th sm sop n in th sm tgory issu in nothr EASA Mmr Stt whih ws rvok or suspn in ny othr EASA Mmr Stt. tht th inormtion provi r orrt. I m wr o th onsquns o proviing ls inormtion, suh s ing ni lins, rtiit, rting, uthoristion or ttsttion, or hving it rvok or nll. Nm: Signtur o pplint: Dt n pl: FOCA/EASA Form EASA AMC1 FCL.125 6/6
REPORT FORM LAPL-A SK ILL TES TMG SEP. Block-off: Block-on: Flight time: Landings: Class rating: SEP TMG
REPORT FORM LAPL-A SK ILL TES T Applint Lst nm(s)*: First nm(s)*: Dt o irth: Typ o lin hl: Lin numr: Stt o lin issu: 1 First ttmpt: Dtil o th light : Typ Dt o light: o ropln: Clss rting: Rgistrtion: Dprtur:
The ATO confirms that the candidate has been trained according to the approved syllabus and assures the level of proficiency required.
Frl Dprtmnt o th Environmnt, Trnsport, Enry n Communitions DETEC Frl Oi o Civil Avition FOCA Sty Division Fliht Prsonnl 3003 Brn CPL(A) Skill tst Applition n rport orm Applint's lin numr: Applint lst nm:
REPORT FORM PPL(A) SK ILL TES. Rating: Block-off: Block-on: Flight time: Landings: Type Rating: Class:
Applint Lst nm(s)*: First nm(s)*: Dt o birth: REPORT FORM PPL(A) SK ILL TES T o lin hl: Lin numbr: Stt o lin issu: 1 First ttmpt: Dtil o th liht : Dt o liht: o ropln: Clss: Ristrtion: Rtin: Dprtur: Dstintion:
EIR(A) AEROPLANE SKILLTEST PROFICIENCY CHECK SE ME Application and report form A. Udfyldes af ansøgeren/to be filled out by the applicant:
EIR(A) AEROPLANE SKILLTEST PROFICIENCY CHECK SE ME Applition n rport form A. Ufyls f nsøgrn/to fill out y th pplint: CPR-nr./Dt of Birth: Crtifikt nr./lin no.: (If ny) Ustn Stt/Stt of Lin Issu: Fornvn/First
Result of the test Section 4:
SKILL TEST IR(A) AEROPLANE SE ME Applition n rport orm A. Uyls nsøgrn/to ill out y th pplint: Dt o Birth: Crtiikt nr./lin no.: (I ny) Ustn Stt/Stt o Lin Issu: Fornvn/First nm(s): Etrnvn/Lst nm: G llr vj:/strt:
Result of the test Section 3:
SKILL TEST LAPL(H) HELICOPTER Applition n rport orm A. Uyls nsøgrn/to ill out y th pplint: Dt o Birth: Crtiikt nr./lin no.: (I ny) Ustn Stt/Stt o Lin Issu: Fornvn/First nm(s): Etrnvn/Lst nm: G llr vj/strt:
SKILL TEST PPL(A) AEROPLANE SE ME Application and report form A. Udfyldes af ansøgeren/to be filled out by the applicant:
SKILL TEST PPL(A) AEROPLANE SE ME Applition n rport orm A. Uyls nsørn/to ill out y t pplint: CPR-nr./Dt o Birt: Crtiikt nr./lin no.: (I ny) Ustn Stt/Stt o Lin Issu: Fornvn/First nm(s): Etrnvn/Lst nm: G
Result of the test Section 4:
SKILL TEST IR(H) HELICOPTER SE ME Applition n rport orm A. Uyls nsørn/to ill out y th pplint: Dt o Birth: Crtiikt nr./lin no.: (I ny) Ustn Stt/Stt o Lin Issu: Fornvn/First nm(s): Etrnvn/Lst nm: G llr vj:/strt:
FI.IR(H) TRI-SP(H) TRI-SP(H) removal of restriction
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REPORT FORM IR(H) INITAL SKILL TEST. (Use Type or Class Rating forms to revalidate IR(H) or renew expired IR(H)) Yes. Type Rating: Rotor stop:
Applint Lst nme(s)*: First nme(s)*: Dte of irth: REPORT FORM IR(H) INITAL SKILL TEST Type of liene hel: Liene numer: Stte of liene issue: (Use Type or Clss Rting forms to revlite IR(H) or renew expire
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The ATO confirms that the candidate has been trained according to the approved syllabus and assures the level of proficiency required
Federal Department of the Environment, Transport, Energy and Communications DETEC Federal Office of Civil Aviation FOCA Safety Division Flight Personnel 3003 Bern CB IR Skill test competency based IR Application
place of birth: place of origin: nationality: repetition of failed / partial passed IR skill test, from date:
Federal Department of the Environment, Transport, Energy and Communications DETEC Federal Office of Civil Aviation FOCA Safety Division Flight Personnel 3003 Bern IR Skill test Application and report form
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Last name: First name: Date of birth: Place of birth: Place of origin: Nationality: Postal code: City: Street: Phone/fax home: Phone/fax office:
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TR IR SP(A) - MPO (except complex-hpa)
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anger of electrical shock, burns or death. lways remove all power sources before attempting any repair, service or diagnostic work. Power can be present from shore power, generator, inverter or battery.
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Danger of electrical shock, burns or death.
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NO VALIDO PARA NAVEGACION REAL
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