ENROLMENT FORM CONFIDENTIAL Add Photo
Max: (100px) x (100px)

 		  
Full Name Mr. / Mrs.
E-Mail Address Nationality
Residential Address Office Address
Home Tel Office Tel
Mobile phone Fax no
Occupation Age
Date of Birth Place of Birth
Height Weight
Blood type
Passport number
Date of Issue
Expiry Date
Medical Certificate
Date of Issue
Expiry Date
Hospital
Educational Background (last degree completed)
 Entering D. Finishing D.
COURSES, etc.
Marital Status
 Single / Married / Divorced / Widowed
Date of Marriage
PARTICULARS OF SPOUSE OR NEXT OF KIN
Name Relationship
Occupation Telephone
COMPUTER KNOWLEDGE
Do you have computer knowledge? Yes / No Programs (Word, excel, . . )
Do you have internet experiences? Yes / No
OTHER INFORMATION
Military Service Completed Yes | Date | No | Possible Date
Driving License Yes / No | Nr | Class
Where did you hear of DUHA Aviation School ? Friends / Advertisements / Agency
Do you smoke? Yes / No
Do you know swimming? Yes / No
Do you have any allergies? Yes / No
Do you take any medication? Yes / No
Do you require a special diet? Yes / No
Have you had any medical/psychological or social problems that may affect your ability to follow or complete the course satisfactorily? Yes / No
LANGUAGES (fluent, good, satisfactory, poor))
Language Level of Profiency
Written Spoken
SOCIAL LIFE
Hobbies and other activities
Membership of club, association etc
Emergency contact name and phone number   Tel
AVIATION BACKGROUND AND EXPERIENCE
Please Tick The Appropriate Box (es) Last Position Held Period of Employment
Fr.(Mth/Yr) To (Mth/Yr)
Air force / Navy / Army
Flying School
Others (Give details)
ANSWER THE FOLLOWING QUESTION BY SELECT ‘YES’ OR ‘NO’ IN THE BOXES PROVIDED.
IF ‘YES’ GIVE DETAILS IN THE RIGHT HAND MARGIN
1. Have you ever been charged with any offence by
any Court or detained by the authorities under the
provisions of any law in any Country?
(Important: Please note you must give details of any charges
made against you even if the Court eventually acquitted you).		 Yes |
No
2. Has any Court judgement or order ever been
made against you ordering you to pay a debt to someone?		 Yes |
No
3. Have you any relative in Duha Aviation School. If yes,
please give designation, name and relationship. 		Yes |
No
4. Have you suffered from any mental illness or
disability for which you have received medical
treatment? (e.g. diabetes,tuberculosis, epilepsy,
asthma, etc.)
 Yes |
No
5. Do you have any endorsement on your pilot medical certificate? Yes |
No
6. Do you have any endorsement on your pilot medical certificate? Yes |
No
7. Have you been grounded for medical reasons or has the renewal
of your licence ever been deferred on medical grounds?
 Yes |
No
8. Are you or have you been dependant on
alcohol and drugs?		 Yes |
No
T.GARANTİ BANK Bakırköy Çarşı Brach
 
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