Pilot License Type & Flight Time Record
Pilot License Type: U.S. Restricted ATP U.S. Full ATP Canadian ATP Commercial
Certificate Number:
How did you receive your flight training? (check all that apply):
University/College Flight Academy Flight School U.S. FAR Part 61 Program
U.S. FAR Part 141 Program Canadian or other non-U.S. civilian flight training
Flight Time Record (in Hours): + + =
Airline Military Other Total
Military Experience
Branch of Service:
Army (U.S.) Army (Canadian) Air Force (U.S.) Air Force (Royal Canadian) Navy (Royal Canadian)
Navy (U.S.) Marines (U.S.) Marines (Canadian) Coast Guard (U.S.) Coast Guard (Canadian)
Years of Service: From (YYYY): To (YYYY):
Current Status:
Discharged Retired Currently Serve - Reserves Currently Serve – National Guard Not Specified
Union Data
Have you ever applied for ALPA membership or worked for an ALPA represented carrier?
If, ‘Yes’: Airline: ALPA Number:
Signature
Upon approval of membership, I agree to pay the required fees, assessments, and annual dues.
I agree to abide by the Constitution and By-Laws of the Air Line Pilots Association, International, as they are now in force, or as
they may hereafter be amended, changed, modified, or adopted.
Signature: Date:
For Administrative Use Only
Membership Approval
The Applicant is: Approved Disapproved for Apprentice Reactivated Active
Membership by COUNCIL number: If disapproved, state reason:
Signature: Date:
(Council Officer or Designee)
Association Approval
The Applicant is: Approved Disapproved Assigned ALPA Number:
Signature: Date:
(Vice President – Administration)
or locked out by that airline?
Have you ever worked as a pilot
for an airline at
a time when its pilots, represented by ALPA, were authorized on
strike
Yes
No
If
‘Yes’:
Airline:
From:
To:
Yes No
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