Form SRG1418 "Air Traffic Controller Training" - United Kingdom

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AIR TRAFFIC CONTROLLER TRAINING
This form is intended for use by UK certificated ATC Initial Training Organisations to provide information about Air Traffic Controller
training courses and assessments to the CAA's ATS Licensing Assessment department and ATS inspectorate. This includes Initial
Training courses, Practical Instructor and Assessor training courses, Adapted Unit Endorsement Courses(UEC’s), undertaken at an ITO,
and Assessment of Previous Competence (APC).
Section A and columns 1, 2 and 3 of Section B are to be completed and a copy of the form is to be sent to ATS Licensing Assessment,
Safety Regulation Group, Civil Aviation Authority, Aviation House, Gatwick Airport South, West Sussex, RH6 0YR at least three weeks
prior to the start date of the course.
After the course, columns 4, 5 and 6 of Section B and Section C are to be completed. The completed form should then be sent to ATS
Licensing within 2 weeks of the end of the course.
FALSE REPRESENTATION STATEMENT
It is an offence under the UK Air Navigation Order to make, with intent to deceive, any false representation for the purpose
of procuring the grant, issue, renewal or variation of any certificate, licence, approval, permission or other document. This offence
is punishable on summary conviction by a fine and on conviction on indictment with an unlimited fine, imprisonment or both.
SECTION A: RATING COURSE DETAILS
Name of Training Organisation: .....................................................................................................................................................................
Title of Approved Training Course: ................................................................................................................................................................
Course Reference Number: ..........................................................................................................................................................................
Start Date of Course: .........................................
End Date of Course: ..........................................
SECTION B: COURSE ATTENDEE DETAILS
Note: Columns 1 to 3 should be completed in advance of the course. Columns 4 to 6 are to be completed after the course
has finished.
1
2
3
4
5
6
ATC Licence
English
Satisfactory (S)/
Comment
Number/CAA
Language
Surname
Forenames
Unsatisfactory
(if any)
1
Medical Number
2
Proficiency
(U)
1. If Licence Number or Medical Number unknown, please insert attendee's date of birth.
2. Insert Level of English Language Proficiency awarded in accordance with the ICAO Language Proficiency Rating Scale. This is only required for individuals
attending their first rating training course.
SECTION C: DECLARATION BY TRAINING ORGANISATION
I hereby declare that the above results are correct.
Signature: ................................................
Date: ..........................................................
Name: .....................................................
Position: .....................................................
Form SRG1418 Issue03, August 2020
Page 1 of 1
AIR TRAFFIC CONTROLLER TRAINING
This form is intended for use by UK certificated ATC Initial Training Organisations to provide information about Air Traffic Controller
training courses and assessments to the CAA's ATS Licensing Assessment department and ATS inspectorate. This includes Initial
Training courses, Practical Instructor and Assessor training courses, Adapted Unit Endorsement Courses(UEC’s), undertaken at an ITO,
and Assessment of Previous Competence (APC).
Section A and columns 1, 2 and 3 of Section B are to be completed and a copy of the form is to be sent to ATS Licensing Assessment,
Safety Regulation Group, Civil Aviation Authority, Aviation House, Gatwick Airport South, West Sussex, RH6 0YR at least three weeks
prior to the start date of the course.
After the course, columns 4, 5 and 6 of Section B and Section C are to be completed. The completed form should then be sent to ATS
Licensing within 2 weeks of the end of the course.
FALSE REPRESENTATION STATEMENT
It is an offence under the UK Air Navigation Order to make, with intent to deceive, any false representation for the purpose
of procuring the grant, issue, renewal or variation of any certificate, licence, approval, permission or other document. This offence
is punishable on summary conviction by a fine and on conviction on indictment with an unlimited fine, imprisonment or both.
SECTION A: RATING COURSE DETAILS
Name of Training Organisation: .....................................................................................................................................................................
Title of Approved Training Course: ................................................................................................................................................................
Course Reference Number: ..........................................................................................................................................................................
Start Date of Course: .........................................
End Date of Course: ..........................................
SECTION B: COURSE ATTENDEE DETAILS
Note: Columns 1 to 3 should be completed in advance of the course. Columns 4 to 6 are to be completed after the course
has finished.
1
2
3
4
5
6
ATC Licence
English
Satisfactory (S)/
Comment
Number/CAA
Language
Surname
Forenames
Unsatisfactory
(if any)
1
Medical Number
2
Proficiency
(U)
1. If Licence Number or Medical Number unknown, please insert attendee's date of birth.
2. Insert Level of English Language Proficiency awarded in accordance with the ICAO Language Proficiency Rating Scale. This is only required for individuals
attending their first rating training course.
SECTION C: DECLARATION BY TRAINING ORGANISATION
I hereby declare that the above results are correct.
Signature: ................................................
Date: ..........................................................
Name: .....................................................
Position: .....................................................
Form SRG1418 Issue03, August 2020
Page 1 of 1