AIR INDIA LIMITED Paste a recent

FORMAT OF APPLICATION FOR THE POST OF PILOT Passport size

I. a/ Name: MILTON SAM
____________________________________________ photograph

b/ Father’s Name: ____________________________________________

SAMSON ALLACE
(Please do not
staple)
c/ Address: ____________________________________________
MILTON COTTAGE, KUREEPUZHA P.O, PERINAD

____________________________________________
KOLLAM, KERALA, INDIA

Pin Code____________________________________
691 601
d/ Contact Details:
i) Telephone Nos.: _____________________________________

ii) Mobile No.: _____________________________________

9495380777

iii) E-mail id: pilotmiltonsam@hotmail.com

_____________________________________

e/ Date of Birth: 29 - 11 - 1986

_____________________________________

f/ Age (As on 25.09.2017) _______

30 (Years)________(Months)_______
09 27 (Days)

g/ Nationality: INDIAN
_____________________________________
CHRISTIAN - LATIN CATHOLIC
h/ Religion: _____________________________________

II. Category you belong to:

(Please ) SC ST OBC
(In case of OBC, candidates would be required to produce OBC certificate in the prescribed proforma issued by
the appropriate authority for Central Government employment. and the validity of “Non-Creamy layer”
Certificate should not be older than 6 months from the date of eligibility criteria)

III. 326043
Bank Draft No. & Date: ________________________________ 08 - 09 - 2017
Drawn on: _________________________

Name of Institute/ Airline from which Type rating/ Endorsement obtained

________________________________________________________________________________________
NIL
IV. Educational Qualifications: (10+2 and onwards)
Exam. Passed University/ Board Year of Passing Subjects % age of Marks
CLASS 10 KERALA STATE 2002 SCIENCE & MATHS 66%

CLASS 12 KERALA STATE 2004 SCIENCE & MATHS 62%

V. Are you, or have you ever been employed?

(Please . If yes, give details): YES NO
Organisation Designation Period Remarks
From To
EMIRATES AVIATION DEPUTY CHIEF FLIGHT
2015 2016
SERVICES INSTRUCTOR
EMIRATES AVIATION FLIGHT INSTRUCTOR 2012 2015
SERVICES

………2/-
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VI. Do you have Type Rating/Endorsement on A-320/ B737/ B777/ B787 Aircraft?
YES NO
VII. If Yes, please specify the Aircraft: _______________________
VIII. Technical Qualifications: Indian Licence details:
Licence Category Type Rating Lic. Number Date of Issue Validity Remarks
On aircraft From To
CPL / ALTP C172
14502 08-02-2017 08-02-2017 07-02-2022
DA42
FRTO 20255 01-07-2016 01-07-2016 30-06-2021

COP/RTR 14-03-2016
[A] 18954 14-03-2016 28-11-2066
IR ON A-320/
B737/ B777/ B787
C172 14134 08-02-2017 03-05-2016 02-05-2017
or Any Other Aircraft
(Please )
Endorsement
Date on
A-320/ B737 / B777/ NIL
B787 or
Any Other Aircraft
IX. CLASS-I MEDICAL STATUS:
LAST MEDICAL DONE ON MEDICAL VALIDITY UPTO MEDICAL STATUS FIT/UNFIT
24-07-2017 23-07-2018 FIT

X. ENGLISH LANGUAGE PROFICIENCY (ELP):

ELP LEVEL ELP DONE ON ELP VALID TILL
5 06-09-2016 05-09-2022

XI. HOURS FLOWN:

Type of A/C Command Co-pilot or Dual Total Remarks
1. SINGLE ENGINE
1182 : 22 202 : 25 1384 : 47

2. MULTI ENGINE
a/ A-320/ B737/ B777/ B787
Aircraft (Please )
b/ Any other Aircraft DA 42
3 : 50 21 : 30 25 : 20 MULTI ENGINE
(Please specify the aircraft)
Total
1186 : 12 223 : 55 1410 : 07

Grand Total
1186 : 12 223 : 55 1410 : 07
(Single Engine + Multi Engine)
Remarks, if any: ________________________________________________________________
(Please attach copy of the endorsement certificate issued by DGCA)
XII. Did you have any flying incident/accident?
(Please  . If yes, when and brief details thereof YES NO
including punishment/warning awarded (if any)
XIII. DGCA Computer No.: __________________
P - 15450606
Any other information:
I hereby declare that the above information is correct to the best of my knowledge and belief. I understand that if I have
suppressed any factual information, my candidature will be rejected.
Further, I also undertake that have understood the contents of the advertisement thoroughly and fully aware that I would
be required to submit the Bank Guarantee equivalent to the training cost and also to execute Service Agreement and Surety Bond
for Service Agreement before joining. In case, I leave the Company before completion of 10 years of service, I would be liable to
pay Air India Limited an amount as Liquidated Damages indicated in Service Agreement in addition to invocation of the Bank
Guarantee (If Valid).

Date: 18 - 09 - 2017 SIGNATURE OF CANDIDATE