APPLICATION FORM

All information you furnish is treated in confidence and will not be used without your permission. Ensure that your employment record is
continuous. If the space allowed for any question is insufficient please use a separate sheet.
Please print (No hand writing) NOTE: Follow the instructions and format EXACTLY as
describe or Air Japan staff will disqualify your application.
SURNAME : Doe Family Name; (Last Name)
Need to have the Chinese character written if
FORENAME(S) : John Paul Legal Given Name (First Name)
the candidate has Japanese/ Korean/
If you have name in Chinese/Japanese character, please print. Chinese name.
DATE OF BIRTH (DD/MM/YY) : 01/02/80 Needs to be checked
HEIGHT (Centimetres) : 176 WEIGHT (Kilograms) : 82

POSITION APPLYING FOR ; CAPTAIN, F/O

PASSPORT DETAILS The Issue and Expiry date should be the same with attached copy.
PASSPORT NO 1 NA569825 PASSPORT NO 2
COUNTRY USA COUNTRY
(DD/MM/YY) (DD/MM/YY)
DATE OF ISSUE 09/02/17 DATE OF ISSUE
(DD/MM/YY) (DD/MM/YY)
DATE OF EXPIRY 09/02/16 DATE OF EXPIRY
Please don’t leave any field blank. If the field
CONTACT DETAILS does not apply to you please put N/A or None
PERMANENT ADDRESS TEMPORARY ADDRESS
12 Main Street

CITY Springfield CITY

STATE N/A STATE
ZIP CODE 91234 ZIP CODE
COUNTRY USA COUNTRY
TELEPHONE +1 415 522 8444 TELEPHONE
FAX NO +1 415 522 8444 FAX NO
MOBILE +1 23456789 MOBILE
E-MAIL 1 jdoe@[Link] E-MAIL 1
E-MAIL 2 N/A E-MAIL 2

LICENCE
ATPL LICENSE 1 (Current Licence) ATPL LICENSE 2
NUMBER 123456 NUMBER
A320
COMMAND COMMAND
TYPE RATINGS TYPE RATINGS

COUNTRY OF ISSUE USA COUNTRY OF ISSUE

Please pay attention to the date format DD/MM/YY
(DD/MM/YY) (DD/MM/YY)
DATE OF ISSUE 26/08/13 DATE OF ISSUE
(DD/MM/YY) (DD/MM/YY)
DATE OF EXPIRY Perpetual DATE OF EXPIRY
(DD/MM/YY) (DD/MM/YY)
INSTRUMENT RATING 26/08/13 INSTRUMENT RATING
(DD/MM/YY) (DD/MM/YY)
DATE OF EXPIRY Perpetual DATE OF EXPIRY
(DD/MM/YY) (DD/MM/YY)
Radio ISSUE 20/04/94 Radio ISSUE
FAA & CASA License holders may write, "Native or English proficient" English Level is only
ICAO English Level 5 ICAO English Level
applicable to non-native English speaking countries.
(DD/MM/YY) (DD/MM/YY)
DATE OF LAST MEDICAL 25/05/13 DATE OF LAST MEDICAL
(DD/MM/YY) (DD/MM/YY)
DATE OF EXPIRY OF MED 22/06/14 DATE OF EXPIRY OF MED Be sure that you have the right Version
(AUG 2017) OLD Versions will not be
accepted.
If ATPL is Perpetual please write this.
AUG2017
 Enter a reason why you
decided to leave the
EMPLOYMENT HISTORY (If the space allowed is insufficient use a separate sheet) company...
FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING:
10/13 Present Pacific USA Airlines 7000USD Job Advancement
SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE:
Captain A. America 12 Boeing Drive, Los Angeles Airport, California, USA +415 333 4444

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY):

A320 First Officer 892:42 10/13 Present

Please don’t leave any of these fields blank (including company information & Salary). Note - AJX will
not contact your previous or current employer without asking you first. The ‘Reason For Leaving’ field
should have at least something like Career Progression but feel free to elaborate if necessary.
FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES:
DATE: TIME: YES / NO
FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING:
01/11 09/13 West Pacific Airlines 6000USD Airline Bankrupt
SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE:
Captain K. F See 20 Airbus Street, Seattle Airport, Washington, USA +360 123 5555

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY):

A320 First Officer 1575:24 01/11 09/13
A321 First Officer 171:54 01/11 09/13

This part should be filled with the flight time

FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES: by the aircraft types and position.
separated
DATE: TIME: YES / NO
FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING:
11/08 09/10 Acme Air 2000USD Hired by West Pacific
SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE:
Captain Iran Jaya Jalan Merdeka 300, Pangandaran, West Java, 444444, Indonesia +62 2234 56780

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY):

C208 Captain 597:36 12/09 09/10
C208 First Officer 630:18 11/08 11/09

FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES:

DATE: TIME: YES / NO
FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING:

SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE:

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY):

FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES:

DATE: TIME: YES / NO
FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING:

SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE:

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY):

FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES:

DATE: TIME: YES / NO

AUG2016
GENERAL AVIATION and NON-Aviation Employment History
FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING:
03/08 10/08 Chevron Aviation 500USD This was a part time
job to support me
Include any non-aviation related employment from
during flight training. I
College to current.
left when Acme Air
offered me a position.
SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE:
Mr H Burger 1234 Main Street, San Francisco, California, USA +1 415 345 6789

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY):

N/A Fueler N/A 03/08 10/08

FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES:

DATE: TIME: YES / NO
FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING:
12/05 10/08 Taco Bell 500USD This was a part time
job to support me
while I was at
University
SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE:
Mr. B Bio 1234 Kirk Street, San Francisco, California, USA +1 415 345 9999

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY):

N/A Cook N/A 12/05 10/08

FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES:

DATE: TIME: YES / NO
FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING:

SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE:

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY):

FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES:

DATE: TIME: YES / NO
FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING:

SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE:

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY):

FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES:

DATE: TIME: YES / NO
Please include both the training facility and the location
where you obtained all of your licences and ratings. MEL
TRAINING Back Ground Information (Advice ALL Information required)
stands for Multi Engine Land.
*Advice when and where you earned below:-
(MM/YY) (COUNTRY) (PLACE / CITY) (Memo / Notes)
PPL 03/12 USA Central Aviation Training Centre, Florida
(MM/YY) (COUNTRY) (PLACE / CITY) (Memo / Notes)
CPL 09/14 USA Central Aviation Training Centre, Florida
(MM/YY) (COUNTRY) (PLACE / CITY) (Memo / Notes)
MEL 09/14 USA Central Aviation Training Centre, Florida
(MM/YY) (COUNTRY) (PLACE / CITY) (Memo / Notes)
IR 06/09 USA Central Aviation Training Centre, Florida
(MM/YY) (COUNTRY) (PLACE / CITY) (Memo / Notes)
ATPL 06/09 USA Central Aviation Training Centre, Florida
AUG2016
 PERIODS OF UNEMPLOYMENT
Please account for any periods of unemployment of at least 30 days
FROM(MM/YY) TO(MM/YY) REASON
03/13 05/13 Between Aviation Contracts
Please put any period of unemployment of at least 30days down. If
you don’t have any then please put ‘None’

INSTRUCTOR QUALIFICATIONS
TRAINING QUALIFICATIONS
AIRCRAFT AIRLINE
(Line/Base/Ground/Sim etc)
None None None

If you don’t have any then please put ‘None’

You must include ALL aircraft flown (including General Aviation). For piston aircraft,
FLYING EXPERIENCE you may generalize as "General Aviation”. Include the specific models flown. i.e.
FMS 737-200, 737-500, 737-900.
Equipped DATE OF LAST
TOTAL TIME
Glass INSTRUCTOR FLIGHT
AIRCRAFT Cockpit TIME
Command Co-Pilot (DD/MM/YY)
Yes No Time (P1) Time(P2) DUAL
*including SOLO *Including PUS

A321 171:54 12:06 05/07/13

A320 2468:06 20/10/14
C208 597:36 611:48 177:42 22/09/10
BE76 24/09/10
C172 88:48 28/03/12

This needs to match your last

logged flight by aircraft.
The sum of the flight times listed above (P1,
P2 & Dual) must match the totals below

1. When entering aircraft type please specify aircraft series (e.g. B737-200/B737Efis, B747/B747-400)
2. Command (P1) time does not include Cruise Captain time or P1u/s time
3. Do not include Simulator time in flight times
NOTE: Please pay attention to detail and bring your logbook up to date. These flight times MUST match your logbook copies submitted and will be audited.

TOTAL TIME: 4128:00 TOTAL JET TIME*: 1027:30 JET P1: 00:00
Dual Time can be less
TTL P1 (with Solo): 686:24 DUAL TIME: 189:48 than in your logbook. JET P2: 2640:00
TTL P2 (with PUS): 3251:48 / (*PUS: 487:32 ) TOTAL B757/B767 TIME: 00:00

INSTRUMENT TIME: 102:30 EFIS: 2640:00 NIGHT FLIGHT TIME : 1027:24

CROSS COUNTRY TIME: 3968:36 CROSS COUNTRY PIC TIME: 641:30 *CROSS COUNTRY PUS TIME: 128:24
Total Time = TTL P1 + TTL P2 + Dual Time (TTL P1 and TTL P2 must match your logbook. Dual Time can be less than your
Commercial Jet time only-Do not include Helicopter time logbook since the JCAB does not concurrently log PIC and Dual after receiving your PPL. Dual Time is the only exception, all
*PUS = P1US, ICUS time other flight times must match your logbook copies submitted.
*Cross Country PUS Time must be put when Cross Country PIC time is less than 100H

This should match your IMC Instrument

CURRENCY RECORD Time logged and not include any Hood or
Sim Instrument Time.
TOTAL FLYING HOURS IN LAST 6
AIRCRAFT TYPE: A321 P1: 0:00 P2: 142:06
MONTHS

DATE OF LAST PROFICIENCY CHECK ; 01/17, A/C TYPE ; A321, RENEWAL ; 01/18.
DATE OF LAST INSTRUMENT RATING ; 12/16, A/C TYPE ; A321, RENEWAL ; 12/17.

AUG2016
ACCIDENTS/INCIDENTS/ATC VIOLATIONS
Give details of any A/C accidents, incidents or ATC violations in which you have been involved:
None
If you have not received a formal citation by your CAA for an
BACK GROUND INFORMATION accident or incident then please put ‘None’. Bird Strikes and
minor incidents don’t count.
Have you ever been convicted of a criminal offence in a court of law? If yes give details.
Yes / No (If Yes, give details:)

Have you ever been convicted of a violation of any Federal or State Statute for DUI/DWI?
Yes / No (If Yes, give details:)

CURRENT EMPLOYMENT STATUS

If you are currently employed, how are you planning to work for AJX ?

1. Resign from current position

2. Apply for LOA Must select one
3. Currently furloughed
4. Currently unemployed

If your answer is 2 or 3, what is the maximum period of time you can apply for ?

AVAILABILITY FOR EMPLOYMENT / NOTICE TERM

When could you start training if offered position? How long is your notice of resignation to current employer?
If you plan to commute/live in a country that is different to your
Please answer available date (DD/MM/YYYY) or notice term.
current address you will need to provide evidence of your right to
2 Months
reside in that country legally by way of a residency permit or visa
upon application to AJX
COMMUTING DETAILS
If offered position, from which country and city are you planning to commute to Japan?
Los Angeles, USA
If the above commuting city is outside Asia or Oceania, are you willing to relocate if necessary?
If so, where can you relocate?
Brisbane, Australia

EXPERIENCE OF OTHER AIRLINES APPLICATION

Have you ever applied for ANA Group Companies (Air Japan/ANA & JP Express/ANK/ANA WINGS) previously?
YES NO

If yes, which company? Air Japan ANA & JP Express ANK ANA WINGS/A-net
Yes, I underwent screening process in / ( mm / yy ) , which was successful / unsuccessful
Have you ever applied for Japanese airlines previously?
(i.e. JAL, JALways, JAL express, NCA, AirDo, Skymark, StarFlyer, IBEX, Solaseed, Peach & etc.)
YES NO Company name : Only check YES if you actually attended a screening with the airline.

Yes, I underwent screening process in / ( mm / yy ) , which was successful / unsuccessful

DECLARATION
I certify that this application is true and correct to the best of my knowledge and that if any falsification is
found this will be ground for termination of application process or agreement with written notice having
immediate effect.

Signed : John Doe , Date : 13/04/2017 .

Electronic Signature is sufficient

AUG2016
 Autobiographical & Other Relevant Information
(This section should include further relevant information in regards to your application not covered in the attached
application form. This information can cover such topics as; work experience, management experience, explanation
for resigning from previous employers, further information on any accidents or incidents, hobbies and interests etc)
One of these needs to be checked
Applicant Name: John Paul / Doe Applying For ; Captain / First Officer

A short introduction on who I am: I grew up in Canada and moved to the USA as a teenager. I am married, with
no children, and in my spare time I enjoy travelling, playing sports such as golf, tennis and football, reading and
spending time with family and friends.

Being a pilot was always my dream growing up - at the age of Six a friend of my father took us up in a Piper
Archer and I was hooked on flying. After high school I attended University where I completed a Bachelor of
Commerce degree, majoring in Finance, and after completing my studies I began flight training at Airworthy
Flying School in Napa Valley. Here I gained a PPL, CPL and multi-engine instrument rating.

My first job was with a charter company called Acme Air, carrying passengers and cargo throughout Indonesia. I
spent two years in Indonesia and during that time I completed the USA ATP subjects via distance learning. In
2010 I interviewed with West Pacific Airways for a position as a pilot and was offered a job shortly afterwards. I
spent two months in Miami, completing an A320 type rating course and carrying out line training before starting
with West Pacific Airways in January 2011. Based in Seattle, I flew the Airbus A320 and A321, and in October
2013 I changed Airlines to Pacific USA Airways, flying the A320 based in Los Angeles. A highlight of my time at
Pacific USA was being selected to teach CRM to Pilots and Cabin Crew.

I first heard about Air Japan when I was talking to a former employee of the airline in a hotel lobby in Las Vegas.
He had many positive things to say about Air Japan and encouraged me to apply for a First Officer position.
Later, I met Ronald Macdonald, a Captain at Pacific USA who spent many years with Air Japan, and he too had
many positive things to say about the company. I am attracted by the opportunity to fly the Boeing 767, to
experience life in Japan and to use the days off to travel with my wife. I have spent many hours talking to my
family and friends about applying for this position and they are all highly supportive of my application. I am very
keen on joining your company and having recently finished a bond period at my current airline, Air Japan is the
first and only airline I have applied to.

A First Officer position at Air Japan is highly desirable to me, and I believe I have the abilities and personal
qualities you are looking for in a pilot. I appreciate your consideration of my application and I look forward to
interviewing with you.

Kind Regards,
John Doe

Interestingly, Air Japan put quite a lot of weight on this section. They want to know the following:

• How you got into flying

• Where and when you obtained your INITIAL PPL, CPL, ATPL, CIR
• A little about your personal life
• Your hobbies and interests
• List what model series aircraft you have flown in brackets. For example, B 737 (100,200,500) etc.
• Your positive attributes
• Why you would like to fly for Air Japan

Do not use bullet points nor copy and paste your CV. Write this in paragraph format.

AUG2016