Employee Flight Certificate

EMPLOYEE FLIGHT CERTIFICATE

Personal Information

Position and Employment

Reporting Manager:    Start Date:    Employee ID:

Employment History (Most Recent First)

Education

References (Professional)

Flight Qualifications & Medical

Pilot Certificate/License Number:    Issuing Authority:

License Expiration Date:    Medical Certificate Class:    Medical Expiration Date:

Date of Last Proficiency/Check Flight:    Recurrent Training Completed On:

Operational Authorization & Safety

I am requesting authorization to (select as appropriate):  Occupy company aircraft as a non-crewmember    Operate company aircraft as crew

I certify that, to the best of my knowledge, I am physically and mentally fit to perform flight duties on the date of any flight for which I am authorized. I further certify that I will comply with all company flight rules, safety briefings, and any pre-flight or post-flight testing required by company policy.

Legal Disclosures & Consents

At-Will Employment: I understand that my employment relationship with the company is at-will unless expressly modified by a written agreement signed by an authorized company representative. Nothing in this certificate alters that status.

Equal Opportunity: The company maintains a policy of equal opportunity and does not unlawfully discriminate in employment or assignment of duties, including flight assignments.

Authorization to Verify: I authorize the company and its agents to contact prior employers, training providers, certification authorities, medical examiners, and references to verify any information provided in this certificate and to obtain any records relevant to my qualifications for flight duties.

Background Checks and Drug/Alcohol Testing: I consent to reasonable background checks and to pre-employment, random, reasonable suspicion, and post-incident drug and alcohol testing as required by company policy or applicable law for safety-sensitive duties, including operation or occupation of company aircraft.

False Statements: I acknowledge that any material misrepresentation or omission in this certificate may result in disciplinary action, up to and including termination, and may affect my authorization to perform flight duties.

Applicant Certification

I certify under penalty of disciplinary action that the information provided on this Employee Flight Certificate is true, complete, and accurate. I understand that authorization to operate or occupy company aircraft is contingent upon verification of qualifications and satisfactory completion of required training, medical certification, and background checks. I agree to notify the company immediately of any change in my medical, certification, or qualification status that could affect my fitness for flight duties.

By checking the boxes below I expressly consent to the indicated acknowledgements and authorizations:

I certify that all information supplied in this certificate is true and complete.

I authorize release of prior employment, training, and medical records to the company as needed to verify qualifications.

I consent to drug and alcohol testing as required for safety-sensitive flight duties.

Manager / Administrative Use

Manager Comments:

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