flight instructor aeroplane fi(a) assessment of …€¦ · in accordance with ara.gen.315(a), (b)...
TRANSCRIPT
CPR-nr./Date of Birth: Certifikat nr/Licence no: Udstedende Stat/State of Licence Issue:
Fornavne/First name(s): Efternavn/Last name:
Total flight time: Total time single-engine piston or TMG:
Time single-engine piston last 6 months:
Total instrument flight time: Cross-country hours
Flight time Multi-Engine aeroplane (If applying for instructor rating multi-engine)
Total PIC on Class/Type (State Class or type): Flight time on mentioned Class/Type last 12 months:
Date of signature Signature:
FLIGHT INSTRUCTOR AEROPLANE FI(A)
ASSESSMENT OF COMPETENCE
FI(A) Restricted FI(A) IRI(A) CRI SPA ME CRI SPA SE
FI(A) incl. IR FI(A) incl. CR SPA ME FI(A) incl. FI
Application and Report form
A. To be filled out by the applicant:
B. Pre-entry Flight Test according to FCL.930.FI (if required):Name of ATO:
I hereby recommend the above mentioned applicant to begin Flight Instructor(A) Course
Date of Pre-entry Flight Test Name of FI(A) conducting the test: Signature of FI(A):
C. To be filled out by the Examiner of Section 1 (if required):
Date of assessment: Name of Examiner: Examiner authorisation no.:
I hereby verify that the applicant has passed the required training and that the applicant fulfills the requirement for the issue of the applicable instructor rating section 1. I also declare that I have reviewed and applied the relevant national procedures and requirements of the applicant’s competent authority contained in the latest version of the Examiner Differences Document.
Date of signature of Examiner Signature of Examiner
Result of Section 1:
Passed Failed
Remaining sections shall be completed before: (Date)
D. To be completed by the Examiner of Section 2 to 7:
Date of assessment: Name of Examiner or stamp: Examiner authorisation no.:
I hereby verify that the applicant has passed the required training and that the applicant fulfills the requirement for the issue of the applicable instructor rating section 2 – 7. I also declare that I have reviewed and applied the relevant national procedures and requirements of the appli- cant’s competent authority contained in the latest version of the Examiner Differences Document.
Date of signature of Examiner Signature of Examiner
Result of the assessment Section 2:
Passed Failed
Section 3:
Passed Failed
Section 4:
Passed Failed
Section 5:
Passed Failed
Section 6:
Passed Failed
Section 7:
Passed Failed
Final result Section 2 to 7:
Passed Failed
Signature
Instructor (A) October 2017 Side 1 af 5
Total instructional hours
Certification by Head of Training or Chief Ground Instructor: Name of ATO: (Use stamp):
I hereby certify that the applicant has passed the required theoretical training and that the appli- cant fulfils the requirement for the issue of:
FI(A) IRI(A) CRI SPA ME CRI SPA SE
and I hereby apply for the assessment of competence Section 1.
Date for start of training Date for end of training
Date of signature CGI Signature of CGI
Section 1
Part 1:Teaching and Learning
a Visual Presentation
Comments:
b Technical Accuracy
c Clarity of Explanation
d Clarity of Speech
e Instructional Technique
f Use of Models and Aids
g Student Participation
Part 2: Theoretical Knowledge Oral
a Air Law Comments:
B Aircraft General Knowledge
C Flight Performance and Planning
D Human Performance and Limitations
E Meteorology
F Navigation
G Operational Procedures
H Principles of Flight
I Training Administration
Result Section 1: Passed/Failed. Signature Examiner:
Signature of Applicant:
Instructor (A) October 2017 Side 2 af 5
Certification by Head of Training or Chief Flight Instructor: Name of ATO: (Use stamp):
Theoretical knowledge instruction hours: Teaching and learning hours:
Date for start of flight training Date for end of flight training: Flight time during training: Mutual flying:
Date of signature of CFI or HT Signature of CFI or HT
SECTION 2 Pre-Flight Briefing Passed Failed
a Visual Presentation Comments:
b Technical Accuracy
c Clarity of Explanation
d Clarity of Speech
e Instructional Technique
f Use of Models and Aids
g Student Participation
Result Section 2 Passed Failed
SECTION 3 Flight Passed Failed
a Arrangements of Demo Comments:
b Synchronisation of Speech with Demo
c Correction of Faults
d Aircraft handling
e Instructional Technique
f General Airmanship/Safety
g Positioning Use of Airspace
Result Section 3 Passed Failed
SECTION 4 Other Exercises Passed Failed
a Comments:
b
c
d
e
f
g
Result Section 4 Passed Failed Not Applicable
Instructor (A) October 2017 Side 3 af 5
SECTION 5 Multi-Engine Exercises These exercises shall be demonstrated for the single pilot multi-engine class rating instructor rating (CRI SPA ME)
Passed Failed
a Actions following an Engine failure shortly after take-off
Comments:
b A single-engine approach and go around
c A single-engine approach and landing
d
e
f
g
Result Section 5 Passed Failed Not Applicable
SECTION 6 Instrument Exercises Passed Failed
a Comments:
b
c
d
e
f
g
Result Section 6 Passed Failed Not Applicable
SECTION 7 Postflight De-Briefing Passed Failed
a Visual Presentation Comments:
b Technical Accuracy
c Clarity of Explanation
d Clarity of Speech
e Instructional Technique
f Use of Models and Aids
g Student Participation
Result Section 7 Passed Failed
Details of the flight Aircraft Type: Aircraft registration: On block On ground
Departure aerodrome Off block Airborne
Destination aerodrome Total block time Total airborne time No. of landings:
Remarks/Overall assessment/Reasons for failure (if applicable):
Name of instructor present at the assessment:
Signature of Examiner Signature of Applicant:
Instructor (A) October 2017 Side 4 af 5
In accordance with ARA.GEN.315(a), (b) – (c)
Undertegnede bekræfter hermed, at jeg ved ansøgningstidspunktet
1. ikke var i besiddelse af et personligt certifikat, rating, tilladelse ellerattestation med samme anvendelsesområde og i samme kategori udstedt i en anden medlems- stat;
2. ikke har ansøgt om et personligt certifikat, rating, tilladelse ellerattestation med samme anvendelsesområde og i samme kategori i en anden medlemsstat; og
3. aldrig har haft et personligt certifikat, rating, tilladelse eller attestmed samme anvendelsesområde og i samme kategori udstedt i en anden medlemsstat, som ertilbagekaldt eller suspenderet i anden medlemsstat.
Note:
Ukorrekte oplysninger vedrørende ovenstående, kan være diskvalificerende for udstedelse af certifikat, rating, tilladelse m.v.
Undersigned hereby confirm that I at the time of application
1. was not holding any personnel licence, certificate, rating, authorisation orattestation with the same scope and in the same category issued in anotherMember State;
2. has not applied for any personnel licence, certificate, rating, authorisation orattestation with the same scope and in the same category in another MemberState; and
3. has never held any personnel licence, certificate, rating, authorisation or attestation
with the same scope and in the same category issued in another Member Statewhich was revoked or suspended in any other Member State.
4. Note:
Incorrect information regarding the above can be disqualifying for obtaining a certificate, rating, authori- zation, etc.
Dato:/Date:
Underskrift:/Signature:
Instructor (A) October 2017 Side 5 af 5
Side 1 (3)
Edvard Thomsens Vej 14
2300 København S
Telefon 7221 8800
Fax 7262 6790
www.tbst.dk
Notat
Persondatabeskyttelse
I henhold til EU’s databeskyttelsesforordning (GDPR) vil vi i det føl-
gende oplyse dig om, hvordan styrelsen håndterer de personoplysnin-
ger, som vi modtager og behandler om dig.
Vi er dataansvarlig – hvordan kontakter du os?
Trafik-, Bygge- og Boligstyrelsen er dataansvarlig for behandlingen af
de personoplysninger, som vi modtager om dig. Hvis du har spørgs-
mål til styrelsens behandling af dine personoplysninger, er du altid
velkommen til at kontakte os eller Transport-, Bygnings- og Boligmini-
steriets uafhængige databeskyttelsesrådgiver via kontaktoplysninger-
ne nedenfor:
Styrelsens kontaktoplysninger
Edvard Thomsens Vej 14
2300 København S
Telefon: 7221 8800
E-mail: [email protected]
CVR-nr.: 27186386
Databeskyttelsesrådgivers kontaktoplysninger
E-mail: [email protected]
Telefon: 41780531
Formålene med behandlingen af dine personoplysninger
Styrelsen behandler dine personoplysninger til følgende formål:
Udstedelse af instruktørcertifikat.
Notat
Retsgrundlaget for behandlingen af dine personoplysninger
Retsgrundlaget for vores behandling af dine personoplysninger følger
af:
Kommissionens forordning (EU) nr. 1178/2011 af 3. november 2011
om fastsættelse af tekniske krav og administrative procedurer for fly-
vebesætninger i civil luftfart i henhold til Europa-Parlamentets og Rå-
dets forordning (EF) nr. 216/2008 EØS-relevant tekst
Kategorier af personoplysninger
Styrelsen behandler følgende kategorier af personoplysninger om dig:
CPR-nummer
Navn, adresse, e-mail, telefon, certifikatnummer, eksamensresultat -
NB. navn på instruktør, examiner og examiner autorisationsnummer,
evt. samt navn på Head of Training
Modtagere eller kategorier af modtagere
Styrelsen videregiver eller overlader dine personoplysninger til følgen-
de modtagere:
TBST. I forbindelse med tilsyn med Trafik-, Bygge- og Boligstyrelsens myndig-hedsudøvelse, kan EASA (European Aviation Safety Agency) kræve at få doku-menter med dine persondata udleveret som led i tilsynet. EASA er hjemmehø-rende i Tyskland.
Overførsel til modtagere i tredjelande, herunder internationale
organisationer
I forbindelse med tilsyn med Trafik-, Bygge- og Boligstyrelsens myndighedsudø-
velse, kan ICAO (International Civil Aviation Organization) kræve at få doku-
menter med dine persondata udleveret som led i tilsynet. ICAO er en FN-
organisation hjemmehørende i Canada.
Hvor dine personoplysninger stammer fra
Fra ansøger.
Opbevaring af dine personoplysninger
De oplysninger, styrelsen skal journalisere, afleveres løbende til Rigs-
arkivet efter arkivlovens regler og Statens Arkivers bestemmelser
herom. Oplysninger vi modtager, der ikke er omfattet af styrelsens
pligt til at journalisere, vil blive slettet, når vi ikke længere har behov
for dem.
Notat
Dine rettigheder
Du har efter databeskyttelsesforordningen en række rettigheder i for-
hold til vores behandling af oplysninger om dig. Hvis du vil gøre brug
af dine rettigheder skal du kontakte os.
Ret til at se oplysninger
Du har ret til at få indsigt i de oplysninger om dig, som vi behandler
(indsigtsret), eller til at søge om aktindsigt.
Ret til berigtigelse
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Ret til sletning
I særlige tilfælde har du ret til at få slettet oplysninger om dig, inden
tidspunktet for vores almindelige generelle sletning indtræffer. Det
gælder alene oplysninger, som ikke er journaliseringspligtige.
Du kan læse mere om dine rettigheder i Datatilsynets vejledning om
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Klage til Datatilsynet
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med den måde, vi behandler dine personoplysninger på. Du finder Da-
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