U.S. DEPARTMENT OF THE INTERIOR
INTERAGENCY HELICOPTER PILOT
EVALUATION APPLICATION
OAS-64B (1-18)
a. Pilot Name (Last, First)
d. Employer e. Previous Employer
Address Dates Employed Telephone
City, ST ZIP
Previous Employer
Telephone Dates Employed Telephone
Hire Date
f. PIC HELICOPTER
Hours
g. PILOT HISTORY
Date of Last Agency Flight Evaluation _________________ ☐ OAS ☐ USFS
Date of Previous Agency Card _________________ ☐ OAS ☐ USFS
(Attach a copy)
☐YES ☐NO Aircraft accidents within the last 5 years.
☐YES ☐NO FAA vi
olations within the last 5 years.
☐YES ☐NO OAS or USFS pilot card denied, suspended, or revoked.
(Attach details and explanation for each YES)
Total
Last 12 Months
Last 90 Days
More than 12,500 lbs.
Turbine Engine
Reciprocating Engine
Mountainous Terrain
h.
14 CFR 135 QUALIFICATIONS
Date Make, Model & Series Type of Qualification
___________ _________________ ☐VFR ☐IFR ☐IFR W/AP ☐SIC Only
___________ _________________ ☐VFR ☐IFR ☐IFR W/AP ☐SIC Only
___________ _________________ ☐ VFR ☐ IFR ☐IFR W/AP ☐SIC Only
___________ _________________ ☐VFR ☐IFR ☐IFR W/AP ☐SIC Only
(Attach FAA 8410-3 or equivalent)
NVG Operations
Night Unaided
Offshore Navigation
Platform Ldgs Vessel Ldgs
NA
Vertical Reference
IFR Simulated
IFR Actual
i. OTHER FAA 14 CFR DOCUMENTATION (dates as required)
61.55 SIC Qualification ____________ 61.56 Flight Review _____________
61.57 IFR Currency ____________ 61.58 PIC Proficiency _____________
133 Demonstration ____________ 137 Demonstration _____________
(Attach a copy of endorsements, letters or logbook entries when requested)
j.
VTR Mtn 12 mo Hours
k. Applicant Remarks
l. I certify that the information listed on this form is true and correct. In addition, I certify that I have read the information provided pursuant to Public Law 93-579 (Privacy Act of 1974).
Pilot: __________________________________________________________________________
(Signature) (Date)
m. ☐I certify that I have verified the information listed on this form and that it is true and correct to the best of my knowledge.
☐I certify that this pilot received a minimum of 10 hours of vertical reference/external load flight training for initial qualification, has received 2 hours of vertical reference longline
training within the past 12 calendar months, and has demonstrated proficiency in accordance the Interagency Helicopter Practical Test Standards.
Company Official: ________________________________________________________________________________________________________
(Print Name and Title) (Signature) (Date)
II. Inspector Information:
a.
Checklist of Documents Verified by the Inspector
☐Pilot Certificate
☐Medical Certificate
☐14 CFR 135 Evaluation
☐14 CFR 137 Endorsement
☐14 CFR 133 Endorsement
☐VTR Training Endorsement
☐Signature Page – Ops & Safety Proc Guide
☐OAS-60B
☐OAS-64C
☐MTN_FLY
☐A110
☐GCNP-SFRA
☐MH1
☐MH2
☐MH3
b.☐ Approved attach OAS-30B c.☐Disapproved (see remarks)
d. Inspector: ____________________________________________________________________________________________________________
(Print Name) (Agency) (Date) (Signature)
e. Remarks: ____________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
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