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
Appendix I I-7
INCIDENTS A search of the FAA Accidents and Incidents on the date of this report revealed the following incidents on file for the certificates listed.
Incident Date Incident Time NTSB ID Name Cert.
Type Cert. Nbr. Position N Number 12/31/2015 0132 NULL Clark Ashcroft ATP 133447710 Pilot in Command (PIC) 373TW INCIDENTS (continued) Incident Date Incident Time Make Model Serial Aircraft Type Airworthiness Type 12/31/2015 0132 Boeing 737 23201 Fixed Wing STD INCIDENTS (continued) Incident Date Incident Time City State Zip Remarks 12/31/2015 0132 Orlando FL 32827 On December 31, 2015, about 10:30 AM Eastern Standard Time, a Boeing 737 airplane, N373TW, landed on taxiway “I” instead of the intended runway 09A at the Orlando Airport (MCO). There were no injuries to the flightcrew or passengers and the plane was not damaged. The flight was conducted under the provisions of 14 CFR part 121 as a regularly scheduled passenger flight from Charlotte Douglas International Airport (CLT). Visual meteorological conditions prevailed at the time of the incident.
NDR REQUEST DATE RECORD A search of the NDR was requested on the following date:
NDR Request Date 11/10/2015
Appendix I I-8
AIR CARRIER DATA The following records have been provided by the airman who:
I hereby certify that I am reporting complete information to the PRD regarding my current employer and all previous employers for whom I have served in a pilot position. Employment records dating to August 1, 2005 may be reported to the PRD by an air carrier in the future. I consent and authorize my current and previous employers to release records pertaining to me as required in accordance with Title 49 of the United States Code (49 U.S.C.) § 44703 to the air carrier(s)/operator(s) selected.
Current Employer Employer Contact Title Address Phone Email AirCarrier Nation Bob Crane Chief Pilot 3033 Control Tower Rd Fayetteville, NC 28305 919-644-8817 Bob.crane@zxcsinc.net Previous Employer(s) Employer Contact Title Address Phone Email Baymount Air Dave Hoover Chief Pilot 1020 Cessna Lane Dallas, TX 555-555-5555 Hoover@Baymount.com Augsburg Airways Dieter Braun Chief Pilot Unknown Unknown D.Braun@AugsburgAirways.de Chugah Air Ethan Yazzie Chief Pilot 550 Airport Freeway Fairbanks, AK 99709 555-343-3412 E.Yazzie@TatumAir.net ——END OF RECORD——
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