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APLICATION

 
 

NEW PILOT APPLICATION

         
Name:   Home Phone:
Street:   Bus. Phone:
City/State:   Employed by:
Soc Sec#:   Driver’s Lic #:
Date of Birth:   E‐mail:
         
FOR RATED PILOTS ONLY:
 
Medical Class: ISSUED: LAST BFR DATE:
           
Pilot Certificate:
           

Category and Class Of Ratings (as printed on your certificate)

 
 
If CFI, Expiration Date:
Have you ever had an occurrence, incident, or accident while operating an aircraft?

Yes No
If Yes, Please explain when, where, dual or PIC, type of A/C and nature of event:
 
 
List aircraft you have flown and approximate number of hours in each
 
 
I agree to pay the deductible part of the insurance coverage on any aircraft dispatched to me belonging to Hayward Flight in the case of an incident of accident, whether in the air or on the ground. ($2,500 moving or non‐moving).
 
Please Initial : I have read, understand and agree to insurance clause I have read and understand the conditions of the rental contract and agree to comply with the rules, regulations, and by‐laws set forth by Hayward Flight and the FAA.
 
Signature: Date: Approved By:
           
 
Check this box if this application is for Ground School
 
 
Hayward Flight 19990 Skywest Dr. Hayward, CA 94541
Tel (510)259‐0824 E‐mail info@haywardflight.com
www.haywardflight.com