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AFI Co-operative Inspectorate Scheme (AFI-CIS)

National Aviation Safety Inspectors proposed for consideration under the AFI-CIS

State :

Biographic Data
Name Date of Birth Nationality



Summary of Qualifications/Experience

Area of specialty

 

Airworthiness

 

A&P
Avionics

 List of ratings held – aircraft types:

Flight Operations

Number of hours flown:

List of ratings held – aircraft types:

Professional Qualifications

License(s) held:
  AME FOO/FD PPL CPL ATPL

Please tick and specify as applicable

 
License No(s).

Issuing Authority

Expiry Date(s)

(if any)

Academic Qualifications

Doctorate Masters Bachelors Diploma Certificate

Please tick and specify as applicable 

CAA Inspector? Yes No

Number of years of experience with CAA:

Experience in certification activities?

Yes No 

Please tick and specify as applicable 

Attended a Certification course? e.g. GSI Course

Yes No 

Please tick and specify as applicable 

Language fluency?

English

French

Please tick and specify as applicable 
List all areas of specialized experience pertaining to Air Operator Certification:
Training Courses Attended (Please attach additional sheets if necessary)
Period Place Title of Course Award received Renewable (Yes/No)
Yes No
Yes No
Yes No
Yes No
Yes No
Employment Record (Please attach additional sheets if necessary)
Date of employment Employer Position held Place of employment Duration

Briefly state main duties/responsibilities of each of the listed positions (Please attach additional sheets if necessary)
I, Title:
hereby confirm the authentification of the information provided relating to:
Mr. / Ms. Date