EmailMe Form - Background Information Form, SimCheck

Your Name *

First Last

Company Name: (type "N/A" if none) *

Address *

City, State, Zip *

Email *

Phone Number, Cell *

### - ### - ####

Emergency Contact, Name/Relationship

Phone Number, Emergency Contact

### - ### - ####

PILOT BACKGROUND and EXPERIENCE

Pilot Certification (check all that apply) *

FAA Pilot Certificate # *

Type Ratings (list all) Include Military Last

Flight Experience (check all that apply)

Please provide Organization Names and Equipment Types
pertinent to above indicated Flight Experience

Automation Experience (check all that apply)

Autopilot

Garmin 430/530

FMS

Garmin G1000

Total Flight Hours (approx) *

Flight Hours, Last 6 Months (approx) *

Flight Hours, Actual IFR (approx.) *

Flight Hours, Multi Engine (if applicable)

Most Frequently Used Airports (ICAO Identifiers,10 Max)

Have you previously completed a formal Simulator Training Course? *

TRAINING OBJECTIVES/INTERESTS (check all that apply)

Any additional background or information pertinent to your capabilities or training needs/requirements:

Approach Plate Experience *

Jeppesen

NACO (Note: SimCheck Uses ForeFlight with NACO EFB)

SECURITY DOCUMENTATION-
SimCheck requires current copies of the following documents prior to commencing simulator training Please remember to present on day 1:

1. Pilot License(s)
2. FAA Medical (preferred)
3. Photo ID (drivers license US Passport Mil ID)
4. Proof of US Citizenship (Passport or Birth Certificate)

Security Documentation: *

has already been submitted.

will submit documentation prior to training.

PILOT BACKGROUND and EXPERIENCE

TRAINING OBJECTIVES/INTERESTS (check all that apply)

SECURITY DOCUMENTATION- SimCheck requires current copies of the following documents prior to commencing simulator training Please remember to present on day 1:

SECURITY DOCUMENTATION-
SimCheck requires current copies of the following documents prior to commencing simulator training Please remember to present on day 1: