Attach color 4x6-sized

photograph taken within the

last six months

FLIGHT DECK APPLICATION FORM

Thank you for your interest in a position to join the flight deck of Batik Air, one of Indonesian
leading and fastest growing airlines. We are looking forward to receiving your complete application.
For a successful, please read these instruction carefully.

1. Do not leave any items blank. If any items are not applicable to you, please indicate “N.A.”
2. Please attach the application form along with the following mandatory copy documents:

Your passport, showing all relevant details and still valid for min 3 years
Your CV or Resume
Flying license(s)
Medical examination valid
Last proficiency check
The last three pages of the logbook (3 Months)
Proof of English proficiency
A recent photograph (two 4x6 sized photos)
Security clearance / Police Letter showing that you have no crime
License Verification Letter
Training Certificates (e.g. RVSM, Dangerous Goods, TCAS, Recurrent, etc)
Training Certificates from TRTO

3. Return all application to Batik Air with enclosed address :

Lion Air Tower 6th Floor, Jl. Gajah Mada No. 7, Jakarta 10130 or [email protected]

False details or intentional suppressions of relevant information and materials will render you
liable to disqualification, or, if appointed, result in automatic termination and / or appropriate
legal proceedings.
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Batik Air maintains a policy of non-disclosure of the rationale for the potential non-selection of
candidates. We will not contact any of the references or contacts at your current employer before
your explicit approval.

Position applied for : Synthetic Flight Instructor (SFI) Captain First Officer

Application Date ( DD/MM/YY ) :

Name :

Title First Middle Last

Current Position: Current Aircraft Type:

Current Employer: Notice Period:

Inclusive of your notice period, how long would it take you to join Lion Air?

Personal Details
Present Postal Address

Resident Tel:
Office Tel:
Mobile Tel:
E-Mail:
Date of Birth (DD/ MM/YY) :
City of Birth:
Country of Birth:
(Present) Nationality:
Do you hold Dual Nationality: Yes No
If yes, please specify:
Passport Number Place of Issue Date of Issue Date of Expiry

Marital Status:

Single Married Divorced Separated Widowed

If married, please provide name of wife / husband:

Children

No Name Custody Relationship Date of Birth Passport

Yes/No DD MM YY Number

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Flying Experience

Please note the following when entering your Flying Hours

1. For aircraft type, include variants. For example, if you have flown the B737-200, B737-300
& B737-800 (or A300B2, A300B4 & A300-600) then show them as separate entries. A
single entry showing total hours on all three types is not acceptable
2. Hours
Please should
state your ICAObe rounded
English to thelevel:
proficiency nearest hour
3. Command hours should only include time when operating as the nominated Pilot-in-
Command (PIC)
4. Cruise Captain hours (P1U/S) should be logged along with First Officer time
5. Second Officer hours should be logged under Second Officer. In addition Flight Engineer
hours should be logged as Second Officer time
6. Please do not include simulator hours

Aircraft with MTOW above 100,000 kg (multi-engine turbojet or turboprop)

Aircraft Hours Flown as
Type Airline Commander Copilot
P1 Date of P1 U/S P2 Second Date of Last Flight
Last (CruiseCapt) Officer
Flight

Total (A) 0 0 0 0

Aircraft with MTOW above 50,000 kg (multi-engine turbojet or turboprop)

Aircraf Hours Flown as
t Airline Commander Copilot
Type P1 Date of P1 U/S P2 Second Date of Last Flight
Last (CruiseCapt) Officer
Flight

Total 0 0 0 0

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(B)

Aircraft with MTOW above 20,000 kg (multi-engine turbojet or turboprop)

Aircraf Hours Flown as
t Airline Commander Copilot
Type P1 Date of P1 U/S P2 Second Date of Last Flight
Last (CruiseCapt) Officer
Flight

Total 0 0 0 0
(C)

Aircraft other than above

Hours Flown as
Aircraft Airlin Commander Copilot
Type e P1 Date of P1 U/S P2 Second Date of Last Flight
Last (CruiseCapt) Officer
Flight

Total (D)
Grand total 0 0 0 0
Total Flying Hours =

P1 P2
Total Jet Hours

4
Remark :

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Do you have an outstanding bond with your current employer: Yes No
If yes, please specify the amount in US$:
Reasons for leaving last position:

Has your licence ever been revoked or suspended? Yes No

If yes, please specify:

Have you ever been employed in an appointment / training capacity? Yes No

If yes please specify:
Type of flying Issuing Licence Date of Date of Limitations
licence authority number 1st issue expiry

FLIGHT DECK INFORMATION

When & Where did you receive your professional flying training and Type Rating?

Have you ever been involved in any aircraft accidents or incidents? Yes No
If yes, please specify:

Medical class Date of Last Medical Date of Expiry Issuing Authority

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Employment and Educational Background

Please indicate your last 5 employers

Dates Gross
Name and city of From To Position Held annual
employer MM YY MM YY salary
package

Dates
Qualifications achieved / Degree From To
received MM YY MM YY
Secondary
education
University /
tertiary
education
Business /
Professional
Other

Please indicate your competency in different languages

[B = basic; I = intermediate; F = fluent; M = mother tongue]

Language Read Write Speak Language Read Write Speak

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References

Please give at least 2 business and 1 personal reference

1 Name
Address

Position / title
Telephone
E-Mail address

2 Name
Address

Position / title
Telephone
E-Mail address

3 Name
Address

Position / title
Telephone
E-Mail address

Please provide us with the details of your Chief Pilot(current Employer-voluntary)

Name
Telephone
E-Mail address

Please provide us with the details of your HR Manager (current Employer-voluntary)

Name
Telephone
E-Mail address

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Miscellaneous

Have you ever been convicted of criminal offence? Yes No

If yes, please provide details:

Have you ever required medical treatment or

Counseling for drug or alcohol abuses? Yes No
If yes, please provide details:

Do you have any relatives employed by

Lion Air or any of its subsidiaries? Yes No
If yes, please provide details:

Do you have any relatives employed by

Lion Air or any of its subsidiaries? Yes No
If yes, please provide details:

Please state why you wish to join Lion Air?

Please tell us how you imagine your potentials life in Lion Air, one year from now!

Please mention any specific qualities or further details that you feel may assist us in placing you in
employment!

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 Medical Section

Please fill out the medical section of this questionnaire. These questions are additional
to the medical and do not replace it. As with the general application form, providing
false details or intentionally suppressing required information will render you liable to
disqualification, or, if appointed, result in automatic termination and / or
appropriate legal proceedings.

Position applied for: Cadet Pilot Captain First

Officer
Name:

Title First Middle Last

General questions
Height [in cm]: Weight [in kg]:

Do you have any pre-existing medical condition / illness? Yes No

If yes, please provide details:

Have you been grounded for medical reasons or has the renewal of your license ever
been deferred on medical grounds? Yes No
If yes, please specify:

Do you wear a) Glasses Yes No

b) Contact lenses Yes No
If yes, please provide details Specify
Do you suffer from colour blindness? Yes No

Do you smoke? Yes No

If yes, please tell us how much you smoke:

Do you drink alcohol? Yes No

If yes, how much do you drink per week?

Thank you for taking the time to fill out this form.

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We are looking forward to receiving your application.

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