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544 Form Pilot Proficiency Check Form
CAAP application form for pilot proficiency check
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: REPUBLIC OF THE PHILIPPINES
INSTRUCTIONS:
Print or Type. Submit original only to the CAAP
or a CAAP Authorized Person. If additional
space is required, use an attachment.
Civil Aviation Authority of the Philippines
MIA Road, Pasay City 1300
PROFICIENCY CHECK FORM
A. APPLICATION IS HEREBY MADE FOR PILOT PROFICIENCY CHECK IN:
1.
TURBOJET AIRCRAFT
2.
FLIGHT ENGINEER
3.
HELICOPTER IFR/VFR/DAY/NIGHT
4.
TURBOPROP AIRCRAFT
5.
9 PAX or 5700kg:IFR/VFR/DAY/NIGHT
6.
HELICOPTER TYPE – VFR DAY ONLY
7.
RECIPROCATING OVER 5700 kg
8.
9 PAX or 5700kg :VFR DAY ONLY
9.
OTHERS (specify) ________________
B. PRE-CHECK NOTIFICATION TO FLIGHT STANDARDS INSPECTORATE SERVICE:
1. DATE OF NOTIFICATION(dd/mm/yyyy)
2. PERSON NOTIFIED
3. DATE/TIME CHECK SCHEDULED
4. LOCATION & CHECK PILOT
C. REQUEST FOR CHECK:
1. I certify that the airman listed in Section D below has completed all applicable training requirements for operations with this company and
request that he or she be checked for the following aircraft, positions and flight operation:
2. AIRCRAFT (MAKE, MODEL)
3. POSITION (PIC/ SIC/SO)
4. FLIGHT OPERATIONS: (DAY, NIGHT, VFR, IFR)
5. MONTH DUE (FOR PROF CHECK)
6. BUSINESS NAME:
7. CERTIFICATE #
8. TELEPHONE
10. DATE (dd/mm/yyyy)
11. SIGNATURE OF COMPANY OFFICIAL (Dir of Ops or Chief Pilot)
9. FAX
12. PRINTED NAME & TITLE OF COMPANY OFFICIAL
D. AIRMAN LICENSE INFORMATION AND FLIGHT HOURS:
1. NAME (Last, First, Middle)
2. LICENSE NUMBER-TYPE
4. CONTACT NUMBER
8. FLIGHT HRS
6 MOS
5. PLACE OF ISSUE
9. PIC HRS
6 MOS
3. RATING(S)
6. DATE ISSUED (dd/mm/yyyyy)
10. DAY LDGS
90 DAYS
11. NIGHT HRS
E. MEDICAL CERTIFICATE INFORMATION:
1. CLASS CERTIFICATE
2. PLACE OF ISSUE
6 MOS
7. EXPIRY DATE (dd/mm/yyyy)
12. NIGHT LDGS
90 DAYS
13. INST HRS
3. DATE OF ISSUE
6 MOS
8. FLIGHT HRS (SO only)
12 MOS
14. TOTAL FLYING HRS
4. MEDICAL EXAMINER
F. PILOT CERTIFICATION:
1. I certify that the above personal and certificate information is true and correct. I further certify that I have completed all applicable initial and/or recurrent training
requirements and meet all PCAR Part 2 and 8 aeronautical experience requirements for the assigned aircraft, position and operations proposed:
2. DATE SIGNED (dd/mm/yyyy)
3. SIGNATURE OF AIRMAN
4. PRINTED NAME OF AIRMAN
G. DOCUMENTATION CERTIFICATION:
1. This is to certify that the following documents of the Airman were reviewed before the actual Proficiency Check and found to be current and complete:
2.
Airman License
3.
Medical Certificate
4.
NTC License
5.
ELP Certificate
6.
Others : _____________________________
7.
Others: ____________________________
H. PROFICIENCY CHECK RESULTS:
1.
Proficiency Check - Oral
(a)
Satisfactory
(b)
Unsatisfactory
(c)
Needs further training as indicated.
2.
Proficiency Check - Simulator
(a)
Satisfactory
(b)
Unsatisfactory
(c)
Needs further training as indicated.
3.
Proficiency Check - Aircraft
(c)
IFR with SIC Authorized
(d)
IRF, Autopilot, No SIC
Aircraft Type and Variant
Needs further training as indicated.
Re-establish Landing Currency
Satisfactory
VFR only
Satisfactory
(e)
4.
(a)
(b)
(a)
(b)
Needs further training as indicated.
I. CHECK CONDUCTED BY: Insert credential, certificate or designated number
1.
CAAP-FSIS
2.
DESIGNATED CHECK AIRMAN
4. DATE CHECK PERFORMED (dd/mm/yyyy)
5. SIGNATURE OF CHECKER
J.
3.
OTHERS (Specify) ______________________
6. PRINTED NAME / TITLE / LICENSE NUMBER
NOTES:
CAAP Form 544 [2.2] 2018
Page 1 of 2
Completion Instructions for Pilot Proficiency Check Form 544 [Front Page]
A1 - 9
Check the applicable box.
D8
Enter flight hours in the last six months.
B1
Enter date & time of notification (dd/mm/yyyy).
D9
Enter PIC hours in the last six months.
B2
Enter person notified (the operator’s assigned POI).
D10
Enter number of day landings in the last 90 days.
B3
Enter date & time Check scheduled.
D11
Enter night hours flown in the last six months.
B4
Enter location and check pilot scheduled.
D12
Enter number of night landings in the last 90 days.
C1
Company Official – Read before signing.
D13
Enter number of instrument hours in the last six months.
C2
Enter make & model of aircraft requested.
D14
Enter number of total flying hours.
C3
Enter assigned position – PIC or SIC or SO.
E1
Enter class of medical certificate.
C4
Enter flight operations requested –
Day, Night VFR or IFR
E2
Enter country where medical certificate issued.
C5
Enter pilot base month for Proficiency Check.
E3
Enter date of issue of medical certificate.
C6
Enter company/business name, if applicable.
E4
Enter name of medical examiner.
C7
Enter Organization Certificate number, if applicable.
F1
Airman – Read before signing.
C8
Enter telephone number.
F2
Enter date signed.
C9
Enter Fax number.
F3
Airman’s signature.
C10
Enter date signed by company official.
F4
Enter full name of airman.
C11
Company Official’s signature.
G1
Examiner - Read before signing on I6.
C12
Enter full name and title of company official.
G2-G5
Mark the boxes the Examiner reviewed to be current and complete
D1
Enter airman full name, last name first.
G6-G7
Enter the specific documents submitted by the Airman, if applicable.
D2
Enter Airman PEL Number & Type of License.
H1 – 4
Mark the applicable type of check and the results –
A – Satisfactory, b – Needs further training, etc.
D3
Enter rating(s) issued.
I1 - 3
Mark the applicable box by whom check performed and enter name and
PEL number.
D4
Enter contact number of the Airman.
I4
Enter date Check performed.
D5
Enter country where airman certificate was issue.
I5
Signature of person performing Check.
D6
Enter date airman certificate issued.
I6
Enter full name, title and PEL Number of person performing Check.
D7
Enter date airman certificate to expire.
J.
Enter additional remarks or notes.
CAAP Form 544 [2.2] 2018
Page 2 of 2
