Appendix 3 FIGURE 1. FAA FORM 8060-11, AIR CARRIER AND OTHER RECORDS REQUEST (PRIA) -- PILOT RECORDS IMPROVEMENT ACT OF 1996, AS AMENDED (FRONT)
AIR CARRIER AND OTHER RECORDS REQUEST (PRIA) -- PILOT RECORDS IMPROVEMENT ACT OF 1996, AS AMENDED Title 49 U.S.C. § 44703(h), Records of Employment of Pilot Applicants NOTICE: Request will not be deemed received or valid unless Parts I through III are completed as specified in the instructions PART I: RECORDS REQUEST (PRIA) To:
, , hereby requests (Air Carrier Name) (Air Carrier Certificate #) copies of records as required under 49 U.S.C. § 44703(h)(1)(B), as amended, pertaining to the airman consenting in Part II below.
Name: Title:
(Print – Air Carrier Representative) (Print -- Title of Air Carrier Representative) Signature: Date:
(Air Carrier Representative) Mail Records To:
Telephone: FAX:
PART II: AIRMAN CONSENT TO RELEASE OF RECORDS I, , consent to and authorize my current or previous employer (Print – Airman’s First, Middle, and Last Name) to release records (Print -- Employer Name) pertaining to me as required under 49 U.S.C. § 44703(h)(1)(B) to the air carrier named in Part I above.
Airman Certificate Number(s):
Signature: Date:
(Not valid unless signed and dated) PART III: AIRMAN NOTICE AND RIGHT TO RECEIVE COPY Pursuant to 49 U.S.C. § 44703(h)(6), you are hereby notified of the foregoing Air Carrier and Other Records Request (PRIA) and that you are entitled to a copy of any and all records furnished in response to the request made in Part I above. My signature belo w serves to waive the requirement under 49 USC § 44703(h)(6) that the person(s) identified in Part I above, which is a person receiving the PRIA request, also provide me with notification of the request and of my right to receive a copy of all records furnished i n response to that request. I may request a copy of such records by checking the appropriate box below.
YES, I want a copy of the furnished records. NO, I do not want a copy of the furnished records.
Signature: Date:
(Not valid unless signed and dated)
Appendix 3 FAA Form 8060-11 (Revised 03/2002) Previous editions are obsolete OMB No. 2120-0607 FIGURE 1 (CONTINUED). FAA FORM 8060-11, AIR CARRIER AND OTHER RECORDS REQUEST (PRIA) -- PILOT RECORDS IMPROVEMENT ACT OF 1996, AS AMENDED (BACK) INSTRUCTIONS: FAA Form 8060-11, AIR CARRIER AND OTHER RECORDS REQUEST (PRIA) -- PILOT RECORDS IMPROVEMENT ACT OF 1996, AS AMENDED, TITLE 49 U.S.C § 44703(h), Records of Employment of Pilot Applicants.
Appendix 3 Air carriers should use this form to request records from current and/or past employers as contemplated under 49 U.S.C.
§ 44703(h).
NOTICE Request will not be deemed received or valid unless Parts I through III are completed as specified below.
A person who receives a request for records under 49 U.S.C. § 44703(h)(1) shall furnish a copy of all such requested records maintained by the person not later than 30 days after receiving the request (see 49 U.S.C. § 44703(h)(5)).
This form may be photocopied for use.
This form is available on the Internet at http://www.faa.gov/avr/afs/pria/.
A separate form must be used for each airman whose records are requested.
DO NOT use this form to request Pilot Records from the Federal Aviation Administration.
PAPERWORK REDUCTION ACT STATEMENT. 49 United States Code (49 U.S.C.) § 44703(h), Records of Employment of Pilot Applicants, as amended, requires all air carriers to request FAA records and Air Carrier and Other Records concerning an indivi dual before allowing that individual to begin service as a pilot. 49 U.S.C. § 44703(h)(8) requires the FAA Administrator to promulgate sta ndard forms to request records. The information entered on the standard forms will be used to facilitate search and retrieval of the required records. It is estimated that the average burden per respondent associated with the collection of Air Carrier and Other Records [this collecti on] is 30 minutes. If you wish to comment on the accuracy of that estimate or submit suggestions for reducing the burden, you may write to: Federal Aviation Administration, Air Transportation Division, AFS-200, 800 Independence Avenue, SW, Washington, DC 20591. The requirem ent to collect background information on the pilots before allowing the pilot to begin service is mandatory; the use of this form is n ot. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a curren tly valid OMB control number. The control number assigned to this collection is 2120-0607.
Part I: To be completed by the Air Carrier.
1. All entries, except for signature, must be either type written or printed legibly with black or dark blue ink.
2. The name, title, and signature of the person making the request on behalf of the air carrier must be legibly entered.
3. A complete mailing address must be furnished to facilitate processing the request.
Part II: To be completed by Airman/Applicant.
1. All entries, except for signature, must be either type written or printed legibly with black or dark blue ink.
2. In the first blank, type or print your name as it is shown on your airman certificate(s).
3. Sign the Consent portion of the form in ink using your legal signature.
4. Type or print your certificate number(s) in the blank provided. In parentheses after the Certificate number, indicate the type of certificate by using S for Student, P for Private, C for Commercial, F for Flight Instructor, G for Ground Instructor, or A for Airline Transport Pilot. If you have multiple certificates that use the same certificate number, list the certificate number once and indicate the types of certificates in parenthesis. For example, if you hold an Air Line Transport Pilot Certificate as well as Flight Instructor and Ground Instructor Certificates using the same number, you should indicate as follows: Certificate No. 456231234 (A,F,G) Part III: To be completed by Airman/Applicant.
1. 49 U.S.C. § 44703(h)(6) requires the person receiving a records request to notify the airman of the request, and further entitles the airman signing FAA Form 8060-11 the right to receive a complete copy of all records furnished in response to a request made by an air carrier. Because FAA Form 8060-11 provides the airman with this notification, a separate notification from the person or air carrier providing the records would be redundant. The airman’s signature on Part III waives the requirement of 49 U.S.C. § 44703(h)(6) that the person(s) or air carrier(s) receiving the records request also provide separate notification of the request and the airman’s right to receive a copy of all records furnished in response to the request.
2. Check the appropriate box to indicate whether you DO or DO NOT want a copy of the records, date & sign in ink using your legal signature. An address for mailing the records must be provided; or, furnish appropriate handling instructions.
Appendix 4 APPENDIX 4. NATIONAL DRIVER REGISTER (NDR) RECORD REQUEST
1. Part I – NDR Record Request. The NDR Record Request is used by the air carrier to request NDR records about an individual seeking employment with the air carrier. Forms can be obtained from the State motor vehicle agency where the air carrier is located. The National Highway Traffic Safety Administration (NHTSA) maintains an Internet database with current addresses and telephone numbers for State motor vehicle agencies This information may be accessed via the Internet at http://www.nhtsa.dot.gov/people/perform/driver/.
a. Probable Identification. The NDR will identify probable matches that require further inquiry for verification. It is strongly recommended that air carriers verify matches with State(s) of record.
b. Identification Information. Records received from the NDR will contain only identification information about the individual, provided by the State(s) that reported the information to the NDR. Specific information regarding the nature of the action that caused the individual to be listed on the NDR will not be provided. Such information should be requested by the air carrier from State(s) of record, after the air carrier verifies that the driver identified in the NDR record and the applicant are the same individual.
c. Period of Availability. Information will not be provided by the NDR if the information was reported to the NDR more than 5 years before the date of the request, unless the information relates to a suspension or revocation of driving privileges that is still in effect on the date of the request.
2. Part II - Consent to Request Records. Used to obtain written consent to the release of the records from the individual who is seeking employment with the air carrier. Requests will not be deemed received or valid if consent has not been provided.
a. To submit a request (with the consent) for the NDR check through a State chief driver licensing official, the individual must provide proof of identification in accordance with State procedures. Acceptable forms of identification may include a notarized signature or, if the consent is delivered by the individual in person, a driver’s license, birth certificate, credit card, employee identification card, or other form of identification normally accepted by the State.
3. Part III – Notice to Prospective Employee. Serves as notice to prospective employees:
(a) of the request; and (b) of their right to receive a copy of any records furnished by submitting a request for such records.
NOTE: Under the provisions of the Privacy Act, an individual may request his or her own report(s) at any time from the NDR office. An individual’s own report will include all records on the individual and to whom they have been disclosed. States have different record retention requirements, e.g., 10 years. As a result, the individual’s report will include anything the State has on file.
Appendix 4 FIGURE 1. SAMPLE NATIONAL DRIVER REGISTER REQUEST Name and Address of Air Carrier PART I – NATIONAL DRIVER REGISTER (NDR) REQUEST This request authorizes the National Highway Traffic Safety Administration (NHTSA) to perform a one-time file search of the National Driver Register (NDR) for information pertaining to me, and to provide the results to the prospective employer listed on this form. This search is to be limited to information about revocations or suspensions st ill in effect on the date of the request or information entered in the NDR in the past 5 years from the date of the request. Upon my request, the prospective employer listed shall make available to me any NDR information received as a result of this search.
Type or Print Clearly (Inquiries that cannot be read will be returned to the air carrier) Full Legal Name (First, Middle, Last) Other Names Used (Maiden, Prior Name, Nickname, Professional Name, Other) Date of Birth (MM/DD/YYYY) Social Security Number (Optional) Driver’s License Number and State Sex Eye Color Height Weight PART II – CONSENT TO RELEASE RECORDS Prospective Employee Understanding: I understand that the National Driver Register (NDR) search w ill result in a printed report which will be sent only to the prospective employer listed on this form. The report will indicate either: (1) that the NDR does not contain a record matching my identification; or, (2) that the NDR has a probable identification (pointer record) from one state (or more) which w ill be named on this r eport. A separate check of state files would be required: (1) to verify the identification; or, (2) to obtain the driving record. Under the Privacy Act, I have the right to request record(s) pertaining to me from the NDR to verify their accuracy.
I hereby, with my notarized signature, authorize a one-time file search of the NDR and any resulting reports to be sent to the prospective employer named on this form.
_____________________________________________________ ______________________ Signature Date PART III – NOTICE TO PROSPECTIVE EMPLOYEE Pursuant to Title 49 United States Code § 44703(h), Records of Employment of Pilot Applicants, as amended, this serves as notice of a request for NDR information concerning your motor vehicle driving record and your right to receive a copy of such information.
Official Use Only NOTARIZATION Date Received Date Sent Internal control Required only if the NDR File Check Request is not made in person by the prospective employee.
Type of Identification ! Valid Photo Driver License ! State-issued Photo ID ! Birth Certificate ! Valid Passport ! Valid Military ID ! Military discharge Papers ! Other (specify) _________________________ Sworn to and ascribed before me Notary Public this_____ day of_____________ Seal or Stamp 20_____ in the city/county ___________________________ State of_____________________ Employee Verifying Applicant Signature Identification (Print Name)