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578 Designated Representative Application Checklist
CAAP application form for designated representative checklist
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: REPUBLIC OF THE PHILIPPINES
Civil Aviation Authority of the Philippines
MIA Road, Pasay City 1300
DESIGNATED REPRESENTATIVE APPLICATION CHECKLIST
A. DESIGNEE PERSONAL INFORMATION:
1. NAME (Last, First, Middle)
3. PEL NUMBER - TYPE
2. COMPLETE PERMANENT ADDRESS
4. TELEPHONE AND FAX
7. DATE OF BIRTH
8. HEIGHT
5. NATIONALITY
9. WEIGHT
10.
6. SEX
HAIR
11. EYES
B. This application is for the following designation: (Check the applicable box)
Original
Renewal
1.
Designated Check Airman
2.
Designated Aviation Medical
3.
Designated Maintenance Examiner
4.
Other Designation
C. SPONSORING COMPANY:
1. Date of Submission: (dd/mm/yyyy)
2. Sponsoring Company Name:
D. State the BUSINESS ADDRESS where the designee will be located:
E. Is a resume (curriculum vitae) attached that outlines in ascending chronological order the
job/position/experience that are related to the designation sought?
1.
YES
2.
NO
3.
NOT APPLICABLE
4. If “NO” or “NOT APPLICABLE” state the reason in this block:
F. Is a listing of related formal training attached that is related to the designation sought and arranged in
ascending chronological order?
1.
YES
2.
NO
3.
NOT APPLICABLE
5. If “NO” or “NOT APPLICABLE” state the reason in this block:
G. State the PERCEIVED NEED that the designation would alleviate:
CAAP Form 578 [1] 2018
Page 1 of 2
H. State the FUNCTIONS that are requested:
I. State the LIMITATIONS that should be designated:
J. Is this designation to be based on another CAA’s designation and is a copy of that designation attached?
1.
YES
2.
NO
3.
NOT APPLICABLE
6. If “YES” include the Designation Number and related CAA phone and fax numbers:
K. I certify that this application and all accompanying document is true and correct:
SIGNATURE
DATE
L. Decision of the CAAP Evaluation Panel:
1.
ACCEPTABLE FOR
2.
PROCESSING
PRINTED NAME & LICENSE NUMBER
INADEQUATE
QUALIFICATION
3.
NEED NOT ESTABLISHED
Panel Member 1 (Name/Position)
Panel Member 2 (Name/Position)
Panel Member 3 (Name/Position)
CAAP Form 544 [1] 2018
Page 2 of 2
