Appendix F F-1 APPENDIX F. OVERVIEW AND USE OF FAA FORM 8060-12 Note: Consult the PRIA website at http://www.faa.gov/pilots/lic_cert/pria/forms_ docs for the most current information on the overview and use of FAA Form 8060-12, Authorization for Release of DOT Drug and Alcohol Testing Records Under PRIA and Maintained Under Title 49 Code of Federal Regulations (49 CFR) Part 40.
1. Part I, Records and A irman Consent for the Release of Records. The hiring air carrier in operation under part 121 or 135, air operator under part 125, or other person (collectively referred to as the “hiring employer”) uses Part I to provide a list of specific drug and alcohol testing records that the previous employer will furnish through this request.
a. Send this form to previous employers that used the individual as a:
• Department of Transportation (DOT)-regulated employee subject to drug and alcohol testing under 49 CFR part 40,
• Non-pilot safety-sensitive employee subject to drug and alcohol testing such as flight attendant (F/A) or maintenance duties, or
• Pilot at any time during the 5-year period preceding the date on the employment application.
b. Use FAA Form 8060-12 to notify the individual:
• That an FAA records request under PRIA for certain DOT drug and alcohol testing records will be conducted.
• Of a request for certain DOT drug and alcohol testing records under PRIA concerning that individual.
• To obtain written consent for the release of such records from that individual who is the subject of the request.
• If the individual has requested a copy of the records, as indicated on FAA Form 8060-11A, Airman Notice and Right to Receive Copy – Air Carrier and Other Records (PRIA), any related DOT drug and alcohol testing records must be copied and included with other PRIA-related records as a result of that request.
2. Part II, Records to Provide. The hiring employer uses Part II to provide a list of questions that the previous employer will complete and return to the hiring employer. The previous employer(s) also use Part II to document the existence of certain DOT drug and alcohol testing records that the previous employer(s) provides to the hiring employer. Consider the following guidelines when either requesting or providing DOT drug and alcohol testing records.
a. Any “no” response in Part II of FAA Form 8060-12 still requires the previous employer(s) to furnish a copy of the appropriate negative drug or alcohol testing results for that respective question. To further clarify, previous employers must provide all test results, including both positive as well as negative DOT drug and alcohol testing results, from over
Appendix F F-2 the last 5 years to the requestor. Obtaining a copy of the form on the DOT website, where previous employers simply “check off” that there were no rule violations, is not acceptable.
b. In addition to obtaining records from all previous employers over the last 5 years, the hiring employer must ask all applicants about their drug and alcohol testing history under DOT agency testing rules to satisfy 49 CFR part 40, § 40.25(j). Unlike the time period required under PRIA, this testing history obtained under 49 CFR § 40.25(j) covers a period of only 2 years. However, PRIA drug and alcohol testing records are not subject to the document retention conditions found in 49 CFR § 40.333. All PRIA records, including drug and alcohol testing records, are required by 49 U.S.C. § 44703(h)(4) to be maintained for at least 5 years. Therefore, to fulfill the requirements of PRIA, a hiring employer must obtain both positive and negative test results for the individual from the last 5 years.
3. Distribution. The hiring employer should attach FAA Form 8060-12 to FAA Forms 8060-11, Air Carrier and Other Records Request (PRIA), and 8060-11A and either mail or fax the forms to all previous employers that used the applicant as a pilot at any time during the previous 5-year period. The hiring employer should provide a copy to the pilot/applicant for that individual’s personal records.
4. Use of FAA Form 8060-12. Even though the use of FAA Form 8060-12 is not currently required, this form has been carefully designed to combine both the records requirements of PRIA with those of 49 CFR part 40. Any employer not in compliance with the drug and alcohol testing record check requirements of 49 CFR part 40 could be subject to an additional inquiry by the Drug Abatement Division (AAM-800). It is a good business practice, therefore, to use FAA Form 8060-12 even if you do not use the other FAA PRIA forms.
5. Instructions. Instructions for completing FAA Form 8060-12 are attached to the form itself.
Overviews and information on the use of this form are in the PRIA Office Procedures for the Air Carrier and on the PRIA website.
6. The Form. There are two online sources for FAA Form 8060-12:
a. http://www.faa.gov/pilots/lic_cert/pria/forms_docs.
b. http://www.faa.gov/forms.
Note: Additional information concerning the inspection of drug and alcohol testing records is in FAA Order 8000.88, PRIA Guidance for FAA Inspectors, paragraph 3-3, Drug and Alcohol Testing Records.
Appendix G G-1 APPENDIX G. OVERVIEW AND USE OF FAA FORM 8060-13 Note: Consult the PRIA website at http://www.faa.gov/pilots/lic_cert/pria/forms_ docs for the most current information on the overview and use of FAA Form 8060-13, National Driver Register Records Request (PRIA).
1. Part I, National Driver Register (NDR) Records Request. The hiring air carrier in operation under part 121 or 135, air operator under part 125, or other person (collectively referred to as the “hiring employer”) uses Part I to request NDR records concerning an individual seeking employment as a pilot with the employer.
2. Part II, Consent to the Release of Records. The hiring employer uses Part II to obtain written consent for the release of the records from the individual who is the subject of the request.
3. Part III, Notice to the Prospective Employee. The hiring employer uses Part III to certify the identity of the individual who is the subject of the request.
a. The hiring company’s representative completes Part III(a) when the individual applies in person.
b. The pilot/applicant must have a notary public complete Parts III(a) and III(b) when the individual does not apply in person.
4. Use of the Pilot/Applicant’s Date of Birth. For all requests to a state’s Department of Motor Vehicles (DMV) or to the NDR, notwithstanding the Privacy Act of 1974 (“the Privacy Act”), disclosure of the pilot/applicant’s date of birth is mandatory. This is for identification purposes, and the DMV or NDR will return most requests without the date of birth with no action being taken by the respondent.
5. Distribution. NDR requirements vary from state to state, and therefore, it is not practical to establish one firm procedure that will satisfy all requests. Notwithstanding, the requesting employer should begin its NDR request process in the manner described in AC 120-68, Pilot Records Improvement Act and the Pilot Records Database, or in the PRIA Office Procedures for the Air Carrier to establish a request process that will produce the most reliable and consistent results for the state.
6. National Highway Traffic Safety Administration (NHTSA). The NHTSA maintains an Internet database with current addresses and telephone numbers for state DMVs. This information is available at http://www.onlinedmv.com.
7. Copies Requested by the Pilot/Applicant. Neither the DMV of any state nor the NDR will furnish an additional copy of a report requested under the authority of PRIA. Therefore, if a pilot/applicant has checked the “yes” block on FAA Form 8060-11A, Airman Notice and Right to Receive Copy – Air Carrier and Other Records (PRIA), the hiring employer will need to furnish the copy after it receives the report.
Appendix G G-2
8. The Form. There are two online sources for FAA Form 8060-13:
a. https://www.faa.gov/pilots/lic_cert/pria/forms_docs/.
b. http://www.faa.gov/forms.
Note: Not all state DMVs accept FAA Form 8060-13 because they are not familiar with the form itself, or prefer to use their own form. If this is the case, use the NDR or DMV request form provided by the state, which is usually available on their website.
9. Instructions. Instructions for completing FAA Form 8060-13 are attached to the form itself.
Overviews and information on the use of this form are in the PRIA Office Procedures for the Air Carrier and on the PRIA website.
10. Additional Tips. Many state DMVs will not accept copies of a request form, so it is advisable to always submit the request in original form. As a result, the hiring employer must mail the request instead of faxing it. We recommend that you use a certified mail delivery that will document the receipt of your request. It is also a good idea to start the request process with a phone call to the state DMV to make sure you have covered all of the requirements of that particular state.
11. NDR Data System Match. The hiring employer receives an NDR report that will state that a data system match was not found, meaning that the record of the individual is clean, or that a data system match concerning the motor vehicle driving record of the individual was found and indicated any of the following records:
a. Record of suspension from the previous 5-year period, if applicable.
b. Record of revocation from the previous 5-year period, if applicable.
c. Any conviction of driving under the influence (DUI), if applicable.
12. The NDR Report Adheres to the Following Standards:
a. A completed NDR report without reference to an action taken against the pilot’s driver’s license is considered a clean report. If the report does indicate a clean record, add the report to the pilot/applicant’s PRIA-related records file and the NDR request process is considered complete.
b. If the report does indicate a problem, however, it will point to a specific state in which the problem occurred. In these cases, the record will indicate a possible match, and the hiring employer is required to conduct further investigation. The hiring employer must disclose this information to the individual in an attempt to verify whether a positive match with the pointer record exists, or if the possible match pertains to another individual with similar identifying information.
Appendix G G-3
c. If the resulting investigation confirms the individual as a positive match with the pointer record, the potential employer or the Designated Agent (DA) must send a second NDR request to the state(s) indicated in the initial report to determine the exact nature of the problem.
d. If the resulting investigation confirms that the individual is not a match with the pointer record, then, along with the results of the investigation, the report is considered clean, the matter closed, and the NDR request process completed for that individual.
Appendix H H-1 APPENDIX H. ADDITIONAL PILOT RECORDS What are the additional pilot records that an air carrier or air operator is encouraged to request to assist in the applicant review, selection, and hiring process?
An air carrier or an air operator is encouraged to request FAA records of proficiency/competency and airmen certification practical test results, in addition to the standard PRIA request. This will require a release signed by the pilot in addition to the standard release found on all PRIA forms.
What other additional pilot records may an air carrier or air operator request to assist in the applicant review, selection, and hiring process?
An air carrier or air operator can request pilot records through the Pilot Records Database (PRD) that include an airman’s record history concerning accidents/incidents and enforcement actions (notwithstanding those records that have been expunged by the FAA) from August 1, 2010, through present. Prior to August 1, 2010, these records are available through a Privacy Act of 1974 (“the Privacy Act”) request made to the Aviation Data Systems Branch (AFS-620).
Complete information and sample requests are available on the PRIA website at http://www.faa.gov/pilots/lic_cert/pria/guidance.
An air carrier or air operator can request pilot records dating before August 1, 2010, that include a certificate holder’s “complete airman file” that includes FAA Form 8060-5, Notice of Disapproval of Application, available by request from the Airmen Certification Branch (AFS-760) using Aeronautical Center (AC) Form 8060-72, FOIA Request for Copies to 3rd Party, which is available on the FAA website at https://www.faa.gov/forms/index.cfm/go/document.information/documentID/1019848.
For additional details, contact AFS-760 toll-free at 866-878-2498.
Other airman records that may be requested include FAA Form 8060-5, including the accompanying FAA Form 8710-1, Airman Certificate and/or Rating Application, indicating a failed airman practical test by using AC Form 8060-72, which is available on the FAA website at https://www.faa.gov/forms/index.cfm/go/document.information/documentID/1019848.
For additional details, you may contact AFS-760 toll-free at 866-878-2498.
Appendix I I-1 APPENDIX I. EXAMPLE PRD OUTPUT OF RECORDS REPORT
FOR CURRENT AND/OR PREVIOUS EMPLOYER
BOB CRANE
CHIEF PILOT BAYMOUNT AIR INC.
3033 CONTROL TOWER RD FAYETTEVILLE, NC 28305
AIRMAN CONSENT FOR THE RELEASE OF RECORDS I, CLARK ASHCROFT, consent to and authorize release of records pertaining to me as required under 49 U.S.C. § 44703(i)(1)(B).
Certificate Number: 000047671 Electronic Signature: Clark Ashcroft Date: 7/11/2016 Mailing Address: 1105 JOY LANE, APT 03, LOS ANGELES, CA 90017
Appendix I I-2
FOR CURRENT AND/OR PREVIOUS EMPLOYER
ETHAN YAZZIE
CHIEF PILOT
CHUGAH AIR 550 AIRPORT FREEWAY FAIRBANKS, AK 99709
AIRMAN CONSENT FOR THE RELEASE OF RECORDS I, CLARK ASHCROFT, consent to and authorize release of records pertaining to me as required under 49 U.S.C. § 44703(i)(1)(B).
Certificate Number: 000047671 Electronic Signature: CLARK ASHCROFT Date: 7/11/2016 Mailing Address: 1105 JOY LANE, APT 03, LOS ANGELES, CA 90017
Appendix I I-3
FOR CURRENT AND/OR PREVIOUS EMPLOYER
DIETER BRAUN
CHIEF PILOT
AUGSBURG AIRWAYS D.BRAUN@AUGSBURGAIRWAYS.DE
AIRMAN CONSENT FOR THE RELEASE OF RECORDS I, CLARK ASHCROFT, consent to and authorize release of records pertaining to me as required under 49 U.S.C. § 44703(i)(1)(B).
Certificate Number: 000047671 Electronic Signature: CLARK ASHCROFT Date: 7/11/2016 Mailing Address: 1105 JOY LANE, APT 03, LOS ANGELES, CA 90017
Appendix I I-4 In accordance with Title 49 of the United States Code (U.S.C.) § 44703(i), 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 certificates; ratings and limitations; summaries of legal enforcement actions resulting in a finding of a violation that have not been overturned, which may include violation on current and previous certificates;
summaries of accidents or incidents; and historical employment records. This PRD record contains personally sensitive information and must be 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 Federal Aviation Administration (FAA) authoritative data systems.
• 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 calendar-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. § 40123, which provides that certain voluntarily provided safety and security information is protected from disclosure to encourage persons to provide the information to the 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 (FOIA) (Title 5 of the United States Code (5 U.S.C.) § 552) or other laws, except as provided in 49 U.S.C. § 40123, Title 14 of the Code of Federal Regulations (14 CFR) part 193, and the order designating the information as protected.
The Administrator has issued FAA Order 8000.82, Designation of Aviation Safety Action Program (ASAP) Information as Protected from Public Disclosure Under 14 CFR Part 193, designating certain information from an ASAP as protected from disclosure under 49 U.S.C.
§ 40123.
Appendix I I-5
FAA DATA Airman Information Name: Clark Ashcroft Permanent Address: 1105 Joy Lane, Apt 03, Los Angeles, CA 90017 AIRLINE TRANSPORT PILOT Cert No: 000047671 DOI: 10/15/2015
AIRPLANE SINGLE ENGINE LAND
AIRPLANE MULTI-ENGINE LAND B-737, B-747 Limitations:
COMMERCIAL PRIVILEGES ROTORCRAFT – HELICOPTER B-737NG G-650 BE 300 BH205 Limitations:
B-747 SIC PRIVILEGES ONLY
MEDICAL CERTIFICATE Medical Class: FIRST Med Date: 09/30/2015 Medical Limitations: MUST WEAR CORRECTIVE LENSES.
NOTICES OF DISAPPROVAL The FAA Notices of Disapproval are available electronically after August 2010; from this date forward.
A search of the FAA Comprehensive Airman Information System, on the date of this report, revealed the following disapproval records on file.
Name Cert. Nbr. Disapproval Date Disapproval Rating Disapproval Type Rating Clark Ashcroft 000047671 10/31/2015 INSTH B-757
Appendix I I-6
ENFORCEMENTS A search of the FAA Enforcement Information System on the date of this report revealed the following enforcements on file for the certificates listed.
Violation Date EIR Number Name Certificate Nbr. Cert. Type 12/31/2015 2015CE0300078 Clark Ashcroft 000047671 ATP Enforcement Details:
Certificate: 000047671 Final Action Date: 06/15/2016 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 Date NTSB ID Name Cert Type Cert Nbr. Position N Nbr.
Make Model Series 12/31/15 LAX01LA172B Clark Ashcroft ATP 000047671 SIC N345J Boeing 737 30837