amel form 1 basic exam and resit

.
CAR66 – AIRCRAFT MAINTENANCE LICENSE
APPLICATION FOR GCAA BASIC EXAMINATION & Re-SIT
(Please complete form in BLOCK CAPITAL)
1. PERSONAL DETAILS
GCAA License/Licensing file number (if known)
Full Name (First,Middle,Last)
(Mr./Ms)…………………………………………………………….…………………………………….………...................
Date of Birth (dd/mm/yyyy)……………………………….Place & Country of Birth……………………………………......
Nationality…………………………………………….........Passport No………………………………………………….......
Permanent Address…………………………………………………………………………………………………………......
……………………………………………………………………………………………………………………………….....
Address for Correspondence…………………………………………………………………………………………………...
……………………………………………………………………………………………………………………………….....
……………………………………………………………………………………………………………………………….....
Telephone Number…………………………………………………..Mobile Number……………………………………......
E-mail………………………………………………………………..Fax Number…………………………………………....
2. EMPLOYER’S DETAILS
Name and Address of Employer…………………………………………………………………………………………..…...
…………………………………………………………………………………………………………………….....................
…………………………………………………………………………………….………………………………………........
Telephone Number…………………………………………………..P.O.Box………………………………………………..
Present Designation.....................................................................................................................................................................
Section……………………………………………………………………………………………….........................................
Date Joined :................................................................................................................................................................................
3. APPLICATION
Application for Examination:
In Category A B C
Aeroplane Turbine A1 B1.1
Aeroplane Piston A2 B1.2
Helicopter Turbine A3 B1.3
Helicopter Piston A4 B1.4
Avionics
Base Maintenance Certifying Engineer
B2
C
Is this the first application for examination to GCAA: Yes No
Is the examination being taken for removal of limitations on existing license: Yes No
Is the examination being taken for addition of another category to existing license Yes No
AMEL FORM 01/ Rev 1 Page 1 of 4
Issued October 2011

Please select modules applied for through this application by selecting () the appropriate modules:
Module Exam (MCQ) Module Exam(MCQ)
1 Mathematics 12 Helicopter Aerodynamics, Structures & Systems
2 Physics 13 Aircraft Aerodynamics, Structures & Systems
3 Electrical Fundamentals 14 Propulsion
4 Electronics Fundamentals 15 Gas Turbine Engine
5 Digital Techniques/Electronic 16 Piston Engine
Instrument systems 17 Propeller
6 Materials & Hardware 18 Air Legislation
7 Maintenance Practices Essays
8 Basic Aerodynamics 7 Maintenance Practices
9 Human Factors 9 Human Factor
10 Aviation Legislation 10 Aviation Legislation
11 Aeroplane Aerodynamics, Structures 18 Air Legislation
& Systems
4. EXAMINATION MODULES SUCCESSFULLY COMPLETED WITH GCAA (Please tick appropriate boxes)
None
Module Exam (MCQ) Module Exam(MCQ)
1 Mathematics 12 Helicopter Aerodynamics, Structures & Systems
2 Physics 13 Aircraft Aerodynamics, Structures & Systems
3 Electrical Fundamentals 14 Propulsion
4 Electronics Fundamentals 15 Gas Turbine Engine
5 Digital Techniques/Electronic 16 Piston Engine
Instrument systems 17 Propeller
6 Materials & Hardware 18 Air Legislation
7 Maintenance Practices Essays
8 Basic Aerodynamics 7 Maintenance Practices
9 Human Factors 9 Human Factor
10 Aviation Legislation 10 Aviation Legislation
11 Aeroplane Aerodynamics, Structures 18 Air Legislation
& Systems
AMEL FORM 01/Rev 1 Page 2 of 4
Issued October 2011

5. DECLARATION
I hereby declare and certify all information that I have furnished on this form is true and correct to the best of my
knowledge and belief. I undertake that I have not taken examination in any of the modules applied in this application
within the last ninety (90) days. I understand any false or misleading statement may result in the refusal of this application
or revocation / suspension of the licence.
SIGNATURE OF APPLICANT: __________________________
6. QUALITY MANAGER’S RECOMMENDATIONS
DATE: ________________
Day / Month / Year
I confirm that __________________________________________________________________ is working in our
organization in the capacity of ______________________________________________________________________
and recommend his application for the examination applied for in Section 3 of this application.
Name……………………………………………………………...Position……………….…………………………..............
Company………………………………………………………….Approval number…………………………………............
Telephone Number……………………………………………….E-mail……………………………………………..............
Signature……………………………………………………….....Date……………………………………………….............
Stamp.........................................................................................................................................................
7. DOCUMENTs CHECKLIST ( For GCAA USE )
Candidate to ensure submission of the manuals/documents along with this application
Document Submitted Not Submitted
1 Covering letter from employer
2 Copies of previous GCAA examination results ( as applicable )
3 One recent colour photograph with white background
(with initial application only)
4 Copy of Passport and valid Visa page
5 Applicable licensing fee
8. INSPECTOR REMARKS (For GCAA Use)
□ Recommended
□ Not Recommended
Inspector Name: ___________________________________________________________________________________
Signature: ____________________________________ Date:______________________________________________
AMEL FORM 01/Rev 1 Page 3 of 4
Issued October 2011

9 MANAGER – ENGINEERING LICENSING REMARKS (For GCAA Use)
□ Approved
□ Not approved
Name: Signature: Date:
AMEL FORM 01/Rev 1 Page 4 of 4
Issued October 2011