附件一外国驾驶员执照认可证书申请表.doc

附件一： 外国驾驶员执照认可证书申请表 Application for Verification of a Foreign License and/or Rating 用墨水笔或打印填写所有项目Type or Print All Entries in Ink I 基本信息Basic Information 照 片 Photo 1姓名Name as it appears on your pilot License 2国籍Nationality 3出生日期Date of Birth 年Y 月M 日D 4性别Sex □男Male □女Female 5出生地Place of Birth 6在华联系电话Telephone in China 7永久通信地址Permanent Mailing Address 8身份证明名称Type of Identification Document □护照Passport □其它Others 9身份证明编号Identification Document No. 10你是否能正确读、听、说和写汉语吗？Can you read, hear, speak and write the Chinese language? □是Yes □否No 11你是否持有或曾经持有CAAC颁发的驾驶员执照？Do you now hold, or have you ever held a CAAC pilot license? □是Yes □否No 12执照编号License No. 13颁发日期Date of Issue 年Y 月M 日D 14你持有现行有效的体检合格证吗？Do you hold a current Medical Certificate? □是Yes □否No 15合格证种类Class of Certificate 16体检合格日期Date of Examination 年Y 月M 日D II 依据的执照和等级License or Rating Applied for on Basis of 持有外国驾驶员执照Holder of a Current Foreign Pilot License issued by 17国家Country 18执照种类Grade of License 19执照编号License No. 20等级Rating (Enter all ratings that appear on your license) 21你持有的外国执照是否被颁发国暂扣或吊销？Is your foreign license under an order of revocation or suspension by the foreign country that issued your license? □是Yes □否No III声明：我保证填写的上述内容是真实和正确的，并在此授权我原执照颁发国向中国民用航空总局提供所有相关信息。 APPLICANTS STATEMENT: I certify that all statements and answers provided by me on the application form are complete and true to the best of my knowledge and I hereby authorize the issuing CAA to provide all pertinent information to CAAC. 22申请人签字Signature of Applicant 23申请日期Date of Application 年Y 月M 日D 24提交附件 Attachments □外国执照汉语或英语翻译复印件Copy of Chinese or English Transcription of Foreign Pilot License □外国执照复印件Copy of Foreign Pilot License □体检合格证复印件Copy of Medical Certificate IV 服务单位Service Organization 25单位全称Name of Service Organization 26计划聘用期限Employment Period 从From 年Y 月M 日D至To 年Y 月M 日D 27单位负责人审核