New Zealand Diploma in Aviation Flight Instructor Programme (Level 6)

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Clemence Gibbs
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Application Form New Zealand Diploma in Aviation Flight Instructor Programme (Level 6) Please complete all sections of this application form and return it along with the requested supporting

1 Application Form New Zealand Diploma in Aviation Flight Instructor Programme (Level 6) Please complete all sections of this application form and return it along with the requested supporting information to: L3 Commercial Training Solutions Airline Academy (NZ) Ltd 131 Boyd Road Hamilton International Airport, RD2 Hamilton 3282 New Zealand Attn: Selection Alternatively, you can scan and it to Personal Details Title Given Name Middle Name Family Name Preferred Name Date of Birth Gender Earliest Training Date Contact Information Home Address City Post Code State / Country Home Phone Mobile Phone 1 P a g e

2 Please indicate (tick) which of the following apply to you: I am at least 17 years of age I have achieved 12 credits (or better) in each of Maths, English and [preferably] a Science subject at Level 2 NCEA (or equivalent) I have achieved NCEA Level 2 certificate (or equivalent) I have achieved NCEA Level 3 certificate (or equivalent) or have completed all PPL theory subjects I hold New Zealand Citizenship or have held a New Zealand Permanent Residency Visa for at least 2 years I am eligible to hold and maintain a CAANZ Class 1 medical certificate I consent to a background and CAA/Aviation Security check, including a Criminal Record Check (Priv/F2). The purpose of this is to identify possible causes that may preclude ME from being issued a license I understand the course fees and I am eligible for both a Student Loan and am able to fund the self-funded portion of the course costs If English is your second language: I meet an IELTS requirement 6.0 (with no band below 5.0) or an equivalent English Language examination as defined by the Civil Aviation Authority 2 P a g e

3 Work rights Do you have New Zealand citizenship or New Zealand permanent residency status? Passport Do you have a valid passport? In which country was your passport issued? Due to the nature of this industry, you will be required to undergo certain security checks on you. The following is part of that process and must be answered. Security Have you any reason to believe that you would not be acceptable if a security check were made on you? Convictions Have you ever been convicted of a criminal offence either in Australia, New Zealand or overseas? (Under the Criminal Records (Clean Slate) Act 2004, if you have a conviction which is spent you may answer NO to this question). For more information regarding this please visit this site: ( slateact-2004) Driving Do you have a full driving license? Have you ever been disqualified from driving? Have you committed any driving offences in the last 5 years? 3 P a g e

4 Health How would you describe your health? Are you prepared to undertake a medical examination? Do you have any health concerns that could affect your ability to gain a Class 1 Medical? For more information regarding the requirements to obtain a NZ Class 1 Medical please refer to this site: ( What is your height in Centimeters? What is your weight in Kilograms? Can you swim at least 50m without the use of buoyancy aids? Disclosure If there is any information that may restrict your future employability (medical or otherwise) you must list it below: 4 P a g e

5 Referees 1 st Referee Referee s Address State / Suburb Post Code Country Referee s Telephone Number Relationship To You 2 nd Referee Referee s Address State / Suburb Post Code Country Referee s Telephone Number Relationship To You Education Secondary Schools School Date From Date To Country Tertiary Institutions Institution Date From Date To Country Highest Qualifications Institution Subject Level Grade Year Taken 5 P a g e

6 Employment Are you currently employed? Company Date From Date To Position Flying Experience Aircraft Type Hours Type Hours License Held Aviation Training Qualifications Organization Date From Date To Level/ Qualification To help us direct our marketing effectively, please tell us where you first heard about this programme? Please tick one Friend/Family Roadshow/Open Flight Instructor/Pilot Newspaper Radio Social Media Website Aviation Publication School Other 6 P a g e

7 Please supply the following information to support your application: A copy of your academic records (NCEA Level 2, and Level 3 if available, or equivalent education) A copy of your New Zealand Birth Certificate / Passport / Permanent Resident Status Visa A passport photo Criminal History ( criminal-record ) Demerit and Suspension Records ) Your IRD Number (Proof of IRD Number required) A copy of your Academic IELTS certificate (if applicable) PRIVACY ACT 1993 Please note, the information on this application form and any subsequent assessment results from L3 CTS Airline Academy selection may be provided to our Airline Partners. I hereby recognize that all information provided in this application form is true and correct at the time of completion. Signed: Date: 7 P a g e

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