NOTE: Failure to enter in all of the information below may result in your TSA validation being delayed.
BASIC INFORMATION
First name
Middle name
Last name
Height (please enter in feet)
Weight (please enter in pounds)
Date of Birth (month / day / year)
Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990
Birth country
Nationality
Gender
Gender Male Female
Eye color
Hair color
Aeroservice admissions rep.
CITIZENSHIP INFORMATION
Country of citizenship
Type Current Dual Historical (Please select only one)
Start date
End date
PILOT LICENSE
Pilot license number
Date of issuance
Country issued
Passport number
Status
Current Expired Revoked Suspended
Date issued
Expiration date
Issuing Country / Passport Authority
City of issuance
VISA INFORMATION
Visa type
Visa number
Country where issued
ADDRESS (MOST RECENT)
List all residences held for over 30 days, for the past 5 years, including those outside the United States. Failure to list 5 years worth of addresses will result in a delay of your application and validation.
Type Current Historical
Street address
Country
City
State / Province
Postal code
Home phone number
FAX number
Cell phone number
E-mail address
EMPLOYER INFORMATION
Employer name
Contact name
Occupation
Telephone number
Contact e-mail
PLEASE CHECK THE ONE THAT APPLIES TO YOU
I am an individual who does not work for an airline
I am employed by a foreign air carrier that operates under 14 CFR part 1546;
I have unescorted access authority to a secured area of an airport under U.S.C 4936(a)(1)(A)(ii), 49 CFR 1542.229;
I am a flight crew member who has successfully completed a criminal history records check in accordance with 49 CFR 1544.230; or
I hold an airman’s certificate that is recognized by the FAA or appropriate US military agency, and that permits me to operate a multi-engine aircraft that has a
certificated takeoff weight of 12,500 pounds or more
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