Appendix D D-2 PRD records complete date:
This is the date when the air carrier or operator completes the process of entering all applicable records into the PRD for this particular airman.
Additional records may be added as they become available but this date indicates a hiring employer no longer needs to request records under PRIA in addition to checking the PRD records as the records are current to this date.
No additional records to report to PRD date:
This is the date when the previous employer attests that all records related to this pilot have been provided to the PRD and no additional records are available or expected to be generated.
YYYYMMDD Valid values:
Must be equal to or after separation of employment date and separation of employment date and type must have been entered.
Table D-2. Assignment to Duty (entry of this record is optional) Start date: YYYYMMDD (required) End date: YYYYMMDD (optional, can’t be before start date) Aircraft: Make and Model (Use make/model lookup table) Position: The position in the aircraft that the pilot was assigned during the event.
Valid values:
PIC (Pilot in command) SIC (Second in command)
Appendix E E-1 APPENDIX E. VERIFICATION OF MOTOR VEHICLE DRIVING RECORD SEARCH
AND EVALUATION Table E-1. Data Fields Reporting entity designator: Designator (or PRD equivalent) of the air carrier or operator entering the record (automatically populates with assigned credential).
Reporting entity name: Name of the certificate holder or operator as it appears on the certificate or is otherwise recorded in the FAA records (automatically populates with assigned credential).
Pilot certificate number: Certificate number of the pilot.
Pilot last name: Name of the pilot as it appears on their certificate.
Date when NDR search and evaluation was completed:
The date the NDR record was received and evaluated:
YYYYMMDD
Appendix F APPENDIX F. EXAMPLE PRD OUTPUT OF RECORDS REPORT This is a sample PRD Airman Record (PAR). The PAR design and content is subject to change and the records demonstrated here are only samples and not intended to indicate what records must be reported.
All data in this PRD report is current as of 12/30/2021
FOR CURRENT AND / OR PREVIOUS EMPLOYERS CEO Air Tour Operator One 1 Desert Road Mytown, AZ 00001 United States
PILOT CONSENT FOR THE RELEASE OF RECORDS consent to and authorize release of records pertaining to me as required under 49 USC 44703(h).
Certificate Number:
Electronic Signature:
Date: 12/01/2020 Mailing Address: 100 Main Street, Anyplace OK 00001 Page 1 of 13 The data contained in this PRD record must be used solely for hiring decisions and must not be copied or distributed except in accordance with Public Law 111-216. Printed on 12/30/2021 12:37:50 PM F-1
Appendix F All data in this PRD report is current as of 12/30/2021
FOR CURRENT AND / OR PREVIOUS EMPLOYERS Chief Pilot Air Carrier 121 101 Airport Freeway Big City, IX 00000 United States
PILOT CONSENT FOR THE RELEASE OF RECORDS L,J , consent to and authorize release of records pertaining to me as required under 49 USC 44703(h).
Certificate Number: 000000000 Electronic Signature:
Date: 12/01/2020 Mailing Address: 100 Main Street, Anyplace OK 00001 Page 2 of 13 000000000 Printed on 12/30/2021 12:37:50 PM The data contained in this PRD record must be used solely for hiring decisions and must not be copied or distributed except in accordance with Public Law 111-216 F-2
Appendix F All data in this PRD report is current as of 12/30/2021 In accordance with 49 USC 44703(h), the Airline Safety and Federal Aviation Administration Extension Act of 2010, this PRD record may be used solely for hiring decisions. This PRD record presents verification of a pilot's airman and medical protected from unintended disclosure.
Confidentiality Warning:
This record and any attachments contain confidential and privileged information. If the reader is not the intended recipient, employee, or agent responsible for delivering it to the intended recipient, you are notified that any unauthorized dissemination, publication, copying, or other use of this communication (whether intentional or otherwise) is strictly prohibited and may be illegal.
Notices:
•The following record data was derived from official FAA authoritative data systems.
*This report may include unsatisfactory practical tests, accidents and/or incidents, and/or enforcement reports dated August 1, 2010 and later associated with the current pilot certificate number. Records dated prior to August 2010 may be available via FAA Form AC 8060-72 and the Privacy Act.
• This report will not include open or pending legal action details as they are not releasable until the case is closed.
• Recent applications for an airman certificate, added rating and/or authorization that resulted in the issuance of a temporary certificate issued 120 days or less preceding the date of this report may not have been processed by the Civil Aviation Registry and, consequently, may not appear on the enclosed airman's verification of certificates and/or ratings.
• With regard to administrative actions that may have been issued to the airman named in this PRD record, we will neither confirm nor deny whether such administrative actions exist under exemption 3, which incorporates various nondisclosure provisions that are contained in other federal statutes. In this case, the applicable statute is 49 U.S.C. Section 40123, which provides that certain voluntarily provided safety and security information is protected from disclosure to encourage persons to provide the information to the Federal Aviation Administration (FAA). If the Administrator issues an order designating information as protected under 49 U.S.C. 40123, that information will not be disclosed under the Freedom of Information Act (Title 5 of the United States Code (5 U.S.C.), section 552) or other laws, except as provided in 49 U.S.C 40123, 14 CFR part 193, and the order designating the information as protected. The Administrator has issued FAA Order 8000.82 designating certain information from an Aviation Safety Action Program as protected from disclosure under 49 U.S.C. 40123.
Page 3 of 13 000000000 Printed on 12/30/2021 12:37:50 PM The data contained in this PRD record must be used solely for hiring decisions and must not be copied or distributed except in accordance with Public Law 111-216 F-3
Appendix F All data in this PRD report is current as of 12/30/2021
FAA DATA
PILOT INFORMATION Name:
Permanent Address: 100 MAIN STREET, ANYPLACE OK 00001
AIRLINE TRANSPORT PILOT Cert. No.: 000000000 DOI: 06/02/2017 AAMEL (Airplane Multiengine Land) BAE-146 AVRO RJ C/ASEL (Airplane Single Engine Land) Limitations:
ENGLISH PROFICIENT.
FLIGHT INSTRUCTOR Cert. No: 000000000 DOI: 03/10/2017 F/ASE (Airplane Single Engine) ** Suspended ** Limitations:
VALID ONLY WHEN ACCOMPANIED BY PILOT CERTIFICATE NO. 00000000. EXPIRES: 01 OCT 2018.
MEDICAL CERTIFICATE Medical Class: First Medical Date: 12/14/2020 Limitations:
MUST WEAR CORRECTIVE LENSES.
Page 4 of 13
- 000000000 Printed on 12/30/2021 12:37:50 PM The data contained in this PRD record must be used solely for hiring decisions and must not be copied or distributed except in accordance with Public Law 111-216.
F-4
Appendix F All data in this PRD report is current as of 12/30/2021
NOTICES OF DISAPPROVAL A search of the FAA Comprehensive Airman Information System (CAIS) on the date of this report, revealed the following failed practical tests on file for this pilot.
Name Cert Nbr. Disapproval Disapproval Rate Disapproval Type Rating Date 000000000 9/30/2016 AMES Airplane Multiengine Sea
DRUG AND ALCOHOL A search of the Pilot Records Database (PRD) on the date of this report, revealed the following drug and alcohol records on file for this pilot.
Agency Non-FAA Mode / Test or Test Type Result Description Company Name Occurrence Date Other DOT PHMSA / 11/01/2019 Pre- Refusal to Record of a pre-employment employment submit to alcohol test conducted under 14 Big Rig Oil Company alcohol test CFR § 120.217(a) and confirmed 101 Drill Bit Avenue with a breath alcohol concentration Oilfield, TX of 0.04 or greater.
(555) 555-1212
ENFORCEMENTS A search of the FAA Enforcement Information System, on the date of this report, revealed the following enforcement records on file for the certificates listed.
Violation Date EIR Number Name Cert. Nbr. Cert. Type.
03/17/2017 00000000 ATP Enforcement Details:
Certificate: 000000000 Final Action Date: 09/03/2018 Final Action Final Sanction Final Sanction Amount Certificate Affected CERT SUSPEND DAYS 30 ATP
ACCIDENTS A search of the FAA Accidents and Incidents on the date of this report revealed the following accidents on file for the certificates listed. For further details, search the NTSB accident database: http://www ntsb.gov/ layouts/ntsb.aviation/index.aspx Accident NTSB ID Name Cert. Cert. Nbr. Position N Make Model Serial Date Type Number 3/17/2017 000000000 Pilot in ACME K-5 K-000 Command (PIC) Page 5 of 13 000000000 Printed on 12/30/2021 12:37:50 PM The data contained in this PRD record must be used solely for hiring decisions and must not be copied or distributed except in accordance with Public Law 111-216.
F-5
Appendix F All data in this PRD report is current as of 12/30/2021
INCIDENTS A search of the FAA Accident and Incident Data System (AIDS), on the date of this report, revealed no incidents.
*** Search reveals no records on file *** RAFT
• 000000000 Printed on 12/30/2021 12:37:50 PM The data contained in this PRD record must be used solely for hiring decisions and must not be copied or distributed except in accordance with Public Law 111-216.
F-6
Appendix F All data in this PRD report is current as of 12/30/2021
PILOT ENTERED EXPERIENCE The following list of current and/or previous employers has been provided directly by the pilot. The Federal Aviation Administration has not, nor has any other entity, verified the information provided. It is the reviewing entity's responsibility to verify that the list of current and previous employers is complete and accurate.
CURRENT EMPLOYER(S) Employer Contact Title Address Phone Email AIR CARRIER CHIEF PILOT 100 AIRPORT (555) 555-1212 •.tst 121 FREEWAY
BIG CITY, IX 00000
PREVIOUS EMPLOYER(S) Employer Contact Title Address Phone Email AIR TOUR CEO 1 DESERT (555) 555-1213
OPERATOR ROAD
ONE MYTOWN, AZ 00001 Page 7 of 13
- 000000000 Printed on 12/30/2021 12:37:50 PM The data contained in this PRD record must be used solely for hiring decisions and must not be copied or distributed except in accordance with Public Law 111-216.
F-7
Appendix F All data in this PRD report is current as of 12/30/2021 In accordance with 49 USC 44703(h), the Airline Safety and Federal Aviation Administration Extension Act of 2010, this PRD record may be used solely for hiring decisions. This PRD record presents industry records of employment, disciplinary actions (if any), drug or alcohol incidents (if any) and training. This PRD record contains personally sensitive information and must be protected from unintended disclosure.
The following records have been provided by Reporting Entities in compliance with Public Law 111-216.
AIR CARRIER EXPERIENCE A search of the Reporting Entity data in PRD on the date of this report, revealed the following Employer records on file for the certificates listed.
CURRENT EMPLOYER(S) D Employer Date of Hire Separation Separation Type Records No Additional Status Date Complete Date Records Date 000000000- AIR 01/02/2017 11/01/2021 12/30/2021 E0005 CARRIER 121 (AC121) *Disputed Pending - Pending inaccuracy request to modify record.
PREVIOUS EMPLOYER(S) Employer Date of Hire Separation Separation Type Records No Additional Status Date Complete Date Records Date 000000000- 135 1/9/2017 03/21/2017 Termination - 07/30/2021 07/30/2021 * E0004 CARRIER pilot pertormance (135AC) 000000000- 125 AIR 1/20/2016 01/08/2017 Subsumed by 135 E0003 LLC CARRIER (125LLC) (135AC) 000000000- AIR TOUR 01/4/2015 12/30/2015 Other - details 06/01/2021 06/01/2021 E0002 OPERATOR ONE (ATO01) 000000000- AIR TOUR Comments Defunct: Ceased operations 12/30/2015 E0001 OPERATOR ONE (ATO01) * - Disputed record.
Pending - Pending inaccuracy request to modify record.
EXPERIENCE - DISCIPLINARY ACTION A search of the Reporting Entity data in PRD on the date of this report, revealed the following disciplinary actions on file for the certificates listed.
Record ID Reporting Entity Date of Action Type Removal from Disputed /(Designator Code) Action Operations 000000000- 135 CARRIER (135AC) 03/21/2017 Termination Yes * DA0001 * - Disputed record.
Pending - Pending inaccuracy request to modify record Page 8 of 13 000000000 Printed on 12/30/2021 12:37:50 PM The data contained in this PRD record must be used solely for hiring decisions and must not be copied or distributed except in accordance with Public Law 111-216.
F-8
Appendix F All data in this PRD report is current as of 12/30/2021
EXPERIENCE - DUTIES HISTORY A search of the Reporting Entity data in PRD on the date of this report, revealed the following duties history on file for the certificates listed.
Record ID Reporting Entity Duty Duty Position Make / Model Duty Position Status /(Designator Code) Position (FAA Order Release Date Start Date 8900.1) 00000000- AIR CARRIER 121 01/15/2019 Pilot-in- AVRO RJ DH0006 (AC121) command 00000000- AIR CARRIER 121 09/15/2017 Second-in- AVRO RJ DH0005 (AC121) command 00000000- AIR CARRIER 121 05/02/2017 Second-in- BAE-146 DH0004 (AC121) command 00000000- 135 CARRIER 01/09/2017 Second-in- BAE-146 03/21/2017 DH0003 (135AC) command 00000000- 125 AIR LLC 01/20/2016 Second-in- BAE-146 01/08/2017 DH0002 (125LLC) command 00000000- AIR TOUR 01/04/2015 Second-in- BAE-146 FK-28 12/30/2015 DH0001 OPERATOR ONE command (ATO01) * - Disputed record.
Pending - Pending inaccuracy request to modify record.
EXPERIENCE - DRUG AND ALCOHOL A search of the Reporting Entity data in PRD on the date of this report, revealed the following drug and alcohol records on file for the certificates listed.
Record ID Employer® Test or Test Type Result Description Status Occurrence Date 000000000- 135 CARRIER 03/17/2017 Alcohol Pre-duty use Record of pre-duty Pending DA0001 (135AC) Misuse alcohol use, as defined under 14 CFR § 120.37(d).
* - Disputed record.
Pending - Pending inaccuracy request to modify record.
Page 9 of 13
- 000000000 Printed on 12/30/2021 12:37:50 PM The data contained in this PRD record must be used solely for hiring decisions and must not be copied or distributed except in accordance with Public Law 111-216.
F-9
Appendix F All data in this PRD report is current as of 12/30/2021
EXPERIENCE - TRAINING, QUALIFICATION OR PROFICIENCY RECORDS A search of the Reporting Entity data in PRD on the date of this report, revealed the following training, qualification records on file for the certificates listed.
Record Employer® Start Date End Date Aircraft Duty Program Event Results Status Make / Position Model 00000000- AIR 12/15/2020 12/2020 AVRO PIC Other Sat TPQ0036 CARRIER RJ 121 (AC121 00000000- AIR Comment Vaccine transportation.
TPQ0036 CARRIER 121 (AC121 00000000- AIR 07/16/2020 07/0/2020 AVRO PIC 121 Secondary Sat TPQ0035 CARRIER RJ Subpart Curriculum - 121 (AC121 Y Refresher 00000000- AIR 07/15/2019 07/15/2019 AVRO PIC 121 Secondary Sat TPQ0034 CARRIER RJ Subpart Curriculum - 121 (AC121 Y Requalification 00000000- AIR 01/25/2019 01/27/2019 AVRO PIC 121 Secondary Sat TPQ0033 CARRIER RJ Subpart Curriculum - 121 (AC121 Y Upgrade 00000000- AIR 01/20/2019 01/22/2019 AVRO PIC 121 Secondary Sat TPQ0032 CARRIER RJ Subpart Curriculum - 121 (AC121 Y Conversion 00000000- AIR 01/15/2019 01/17/2019 AVRO PIC 121 Secondary Sat TPQ0031 CARRIER RJ Subpart Curriculum - 121 (AC121 Y Transition 00000000- AIR 01/03/2019 01/08/2019 AVRO PIC 121 Continuing Sat TPQ0030 CARRIER RJ Subpart Qualification 121 (AC121 Y Curriculum - Special Tracking 00000000- AIR 12/01/2018 12/01/2018 AVRO SIC 121 Continuing Sat TPQ0029 CARRIER RJ Subpart Qualification 121 (AC121 Y Curriculum - Line Check 00000000- AIR 07/15/2018 07/15/2018 AVRO SIC 121 Continuing Sat TPQ0028 CARRIER RJ Subpart Qualification 121 Curriculum - (AC121) Line Operational Evaluation 00000000- AIR 01/05/2018 01/05/2018 AVRO SIC 121 Continuing Sat TPQ0027 CARRIER RJ Subpart Qualification 121 Curriculum - (AC121) Maneuvers Validation 00000000- AIR 12/02/2017 12/07/2017 AVRO SIC 121 Continuing Sat TPQ0026 CARRIER RJ Subpart Qualification 121 Y Curriculum - (AC121) Special Qualification Training Page 10 of 13 The data contained in this PRD record must be used solely for hiring decisions and must not be copied or distributed except in accordance with Public Law 111-216. - 000000000 Printed on 12/30/2021 12:37:50 PM F-10