Application for Otago Aviation Academy C-Catergorgy Instrustor Program, Diploma in Aviation Level 6
Personal details
Name
First Name
Last Name
Preferred name
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional personal info
Date of birth
-
Day
-
Month
Year
Date
Gender
Female
Male
Gender Diverse
Prefer not so say
Country of birth
Please provide the name of the country in which you were born (if the country name has changed, please provide current name).
Plesae state your nationality
Ethnicity
Please Select
African
Asian
Australian
British and Irish
Cambodian
Chinese
Cook Islands Maori
Don't Know
Dutch
European
Fijian
Filipino
German
Greek
Indian
Italian
Japanese
Korean
Latin American
Māori
Middle Eastern
New Zealand European
Niuean
Other Asian
Other Ethnicity
Other European
Other Pacific Peoples
Other Southeast Asian
Pacific Peoples
Polish
Samoan
South Slav
Southeast Asian
Sri Lankan
Tokelauan
Tongan
Vietnamese
Not Stated
Do you have indefinite NZ Residency?
Yes
No
Legal work eligibility
No
Yes (NZ citizen)
Yes (NZ permanent resident)
Yes (NZ resident visa)
Yes (NZ work permit holder)
Yes (Australian resident)
Yes (Australian permanent resident)
Yes (Australian citizen)
Yes (other – please specify)
NZ driver licence*
No
New Zealand Full licence
New Zealand Restricted licence
Overseas
Have you had any convictions not covered by the New Zealand Criminal Records (Clean Slate) Act?
Yes
no
Security information - if yes please list all convictions
Have you been sentenced to a custodial sentence (e.g. imprisonment, corrective training, youth justice)?
Yes
No
Security information - previous sentences details
Security information - awaiting charges
Yes
No
Additional Documentation - Use this section to upload any additional documentation that can support your applications.
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Qualifications - Licence Type and Rating
NZ CPL
MEIR
SEIR
BGT/BTK
ILS
VOR
NDB
PAR
GPS
IFR Instructor privilege
Multi-engine aircraft Instructor privilege
Night Instructor privilege
Terrain and Weather Awareness Instructor privilege
At which Flight Training Organisation did you complete your CPL?
Date of Last flight test, BFR or renew
-
Month
-
Day
Year
Date
Class One Medical Certificate – Date of Issue / Renewal
-
Month
-
Day
Year
Date
Flight Time
Have you ever been involved in any aircraft accidents or incidents that resulted in damage to the aircraft or injury to personnel?
Yes
No
Signature Of Applicant
*
Upon signing this appraisal form, the applicant declares that the information provided above is true and correct to the best of my knowledge.
Submit
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