Jayrow Helicopters Pilot Application Form

JR160 Rev 0 15th February 2013

JAYROW HELICOPTERS APPLICATION FOR EMPLOYMENT - PILOT

CONFIDENTIAL
Information collected on this form is used to assess your suitability for employment with Jayrow Helicopters Pty
Ltd. If your application is unsuccessful, this form and accompanying CV will be retained for a period of one year
during which time we will consider you for applicable positions. After one year, we will discard your information
in away, which ensures your privacy is maintained.
Please ensure a current CV is submitted with this application.

Position Applied For: PILOT Date Applied: 05-05-2017

or please indicate if you would like to be added to our Database: Yes, please add me to the database

Date available to commence employment:

PERSONAL DETAILS
Surname:
First Name(s): Preferred Name:
Address:
Phone: Mobile:

Next of Kin: Contact Details:

Countries in which you have citizenship or permanent residency:

Countries in which you are legally entitled to work:(Please attach a copy of your visa/permit)

Do you hold a current drivers licence?

If yes, what class (es)? Yes No

Have you ever been employed by Jayrow Helicopters Pty Ltd? Yes No

If yes, please specify when, position held, and your Manager at the time:

Is there anything that may affect your ability to do the work you are applying for?
Yes No
(medical conditions, injury or impairment/study programmes)
If yes, please advise what they are so the employer can decide whethe r they can be
reasonably accommodated:

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 Jayrow Helicopters Pilot Application Form
JR160 Rev 0 15th February 2013

Are you aware of any factors that would place you in a potential conflict of interest with
Jayrow Helicopters Pty Ltd? Yes No

If yes, please provide details:

Have you been convicted of a criminal offence or are you awaiting hearing of civil charges
Yes No
in a civil or criminal court of law, or are there any criminal charges under investigation?
If yes, please list all the offences, (including driving offences) charges and all details:

QUALIFICATIONS
Please list all relevant qualifications and training courses you have undertaken:
Date Qualifications Gained

MOST RECENT WORK-RELATED EXPERIENCE

Name of Organisation: Position:

Start Date: End Date:

Reason for Leaving:

Name of Organisation: Position:

Start Date: End Date:

Reason for Leaving:

Name of Organisation: Position:

Start Date: End Date:

Reason for Leaving:

Name of Organisation: Position:

Start Date: End Date:

Reason for Leaving:

Name of Organisation: Position:

Start Date: End Date:

Reason for Leaving:

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 Jayrow Helicopters Pilot Application Form
JR160 Rev 0 15th February 2013

AVIATION QUALIFICATIONS
Qualification Expiry Qualification Expiry Qualification Expiry
ASIC DG HUET
CRM First Aid MSIC

AVIATION LICENCES
Type Number Date Issued Endorsement Type

If attaining an ATPL, provide current status:

AVIATION RATINGS
Instrument Yes No Rappelling Yes No
AG Rating Yes No
Renewal Endorsement
Yes No Yes No Yes No
T& C Approval IREX Pass Sling Endorsement

Yes No Low Flying Yes No English Language Yes No

IFR Rating
Approval Prof
Instructor Yes No Yes No
Winch Yes No
NVFR Rating
Rating Endorsement
If able, please attach a copy of all current licenses and qualifications
FLYING EXPERIENCE
Total Hours: Total Hours Rotary: Total Hours Fixed Wing:
Total Hours Rotary Total Hours Total Hours
Multi-Engine: Single Engine: Rotary Turbine:
HELICOPTER TYPE EXPERIENCE
Command ICUS Co-Pilot Dual Instrument
Type
Day Night Day Night Day Night Day Night Sim Actual

Total Hours

Date of last rotary flight and type as Pilot in command :Date Type:

Total hours flown in the last 6 months: Rotary Fixed Wing

If able, please attach a copy of relevant pages of you r personal logbook.

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 Jayrow Helicopters Pilot Application Form
JR160 Rev 0 15th February 2013

ROLE EXPERIENCE Helicopter Command experience in:

Role Hrs Role Hrs Role Hrs Role Hrs
Night flying
Ag Flying Long line SAR
experience
Fire fight bucket Low level Night Sun Ops Multi Crew IFR

Belly tank Medivac Night Vis Goggles Single pilot IFR

IFR experience Mountain flying Offshore Sling exp.

Number of Number of
Day Night Day Night Winching exp.
ship landings: hoists:
Additional information:

If able, please attach a copy of relevant pages of your personal logbook.

RELATED EXPERIENCE
Roles Yes/No Type/Level Hrs Roles Yes/No Type/Level Hrs
Flight safety Yes No OH&S Yes No

Other
AVIATION MEDICAL
Date Due Class medical obtained Disabilities / Limitations

If able, please attach a copy of your latest medical certificate.

ACCIDENT HISTORY Accidents resulting in damage to aircraft
Date Aircraft type Brief details

AVIATION VIOLATIONS
Date Aircraft type Brief Details

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REFEREES
Please provide details of three work related referees Jayrow Helicopters can contact to discuss you and your
ability to perform the role. Referees must be Managers or Supervisors you reported to. You are giving
permission for us to contact these referees, but you will be informed before they are called.
Referees Full Name Working Relationship/Position held/Organisation Contact Phone Number

IS THERE ANYTHING ELSE YOU WOULD LIKE US TO KNOW ABOUT YOUR APPLICATION?

DECLARATION AND AUTHORISATION

I certify that the information I have given on this application is complete, true and correct. I understand that if I have given
incorrect or misleading information, or if I have left out any important information, I may not be considered for
appointment, or if appointed, my employment may be terminated. I authorize the prospective employer to investigate all
statements made on this application and to seek any information about me in relation to this application.

Signature Date

All information is held in the strictest confidence and all candidates are dealt with fairly and without bias. If the
candidate is successful this form will be included in their personnel file.

Do you consent to Jayrow Helicopters retaining the information in this application form for the
Yes No
purposes of considering your suitability for any other position that may arise with us in the future?

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