Form SRG1411B "Application for the Inclusion of Unit Endorsements for New Ratings, Existing Ratings Including Special Events and for the Renewal and Cancellation of Unit Endorsements in an Air Traffic Controller (Atco) Licence (Regulation UK (Eu) 2015/340)" - United Kingdom

ADVERTISEMENT
ADVERTISEMENT

Download Form SRG1411B "Application for the Inclusion of Unit Endorsements for New Ratings, Existing Ratings Including Special Events and for the Renewal and Cancellation of Unit Endorsements in an Air Traffic Controller (Atco) Licence (Regulation UK (Eu) 2015/340)" - United Kingdom

Download PDF

Fill PDF online

Rate (4.8 / 5) 17 votes
Application for the inclusion of Unit Endorsements for new Ratings,
existing Ratings including Special Events and for the Renewal and
Cancellation of Unit Endorsements in an Air Traffic Controller (ATCO)
Licence (Regulation UK (EU) 2015/340)
Please complete this form online (preferred method) then print, sign and submit as instructed.
Alternatively, print, then complete in BLOCK CAPITALS using black or dark blue ink.
Post or scan and email in accordance with Section 8.
Please read attached Guidance Notes before completing this form.
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.
Persons doing so render themselves liable, on summary conviction, to a fine not exceeding the statutory maximum and on
conviction on indictment to an unlimited fine or imprisonment for a term not exceeding two years or both.
1. APPLICATION FOR
(Complete Sections Listed)
Unit Endorsement for a New Rating/Rating Endorsement (2, 3, 4, 5, 7, 8 and 9)
Unit Endorsement for an Existing Rating/Rating Endorsement (2, 3, 4, 7, 8 and 9)
Unit Endorsement to Renew an Expired Unit Endorsement (2, 3, 4, 7, 8 and 9)
Unit Endorsement for a Special Event (Temporary) (2, 3, 4, 7, 8 and 9)
The Cancellation of a Unit Endorsement (2, 6, 7, 8 and 9)
2. PERSONAL DETAILS (Complete as shown on passport)
(Completed by the Applicant)
Serial Number of Licence:
Title: ………………….
Surname: …………..…….…………...
Forename(s): …………………………………..……………..
Date of Birth (dd/mm/yyyy): ………………….…………………..
Nationality: ……………..………………………..……………
Place of Birth: ………………………………..……….……………
Country of Birth: ……………………..……………………….
Applicants Address:
………………………………………………..………………..………..………………………………….…
………………………………………………..…………………..……..………………………………….…
………………………………………………..…………………………..……………………………………
County: …………………………. Postcode: ………………… Country: …………………..…………..
Telephone Numbers:
Home: ……………………………………………… Mobile: ………………………………………………
Email Address: ……………………………………………………………………………………………….
Unit Name:
……………………………………….………..………………..………..………………………………….…
Unit Address:
……………………………………….………..………………..………..………………………………….…
…………………………………….…………..………………..………..………………………………….…
County: …………………………. Postcode: ………………… Country: …………………..…………..
ICAO Location Indicator:
The licence will be sent to the unit by default unless specified otherwise by the unit or individual with an explanation
to: ats.licensing@caa.co.uk.
3. NOTIFICATION OF UNIT ENDORSEMENT ASSESSMENT
(Completed by the Applicant)
Location of assessment: …………………………………………. Proposed date (dd/mm/yyyy): ………………………………..
Form SRG 1411B Issue 04, June 2021
Page 1 of 3
Application for the inclusion of Unit Endorsements for new Ratings,
existing Ratings including Special Events and for the Renewal and
Cancellation of Unit Endorsements in an Air Traffic Controller (ATCO)
Licence (Regulation UK (EU) 2015/340)
Please complete this form online (preferred method) then print, sign and submit as instructed.
Alternatively, print, then complete in BLOCK CAPITALS using black or dark blue ink.
Post or scan and email in accordance with Section 8.
Please read attached Guidance Notes before completing this form.
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.
Persons doing so render themselves liable, on summary conviction, to a fine not exceeding the statutory maximum and on
conviction on indictment to an unlimited fine or imprisonment for a term not exceeding two years or both.
1. APPLICATION FOR
(Complete Sections Listed)
Unit Endorsement for a New Rating/Rating Endorsement (2, 3, 4, 5, 7, 8 and 9)
Unit Endorsement for an Existing Rating/Rating Endorsement (2, 3, 4, 7, 8 and 9)
Unit Endorsement to Renew an Expired Unit Endorsement (2, 3, 4, 7, 8 and 9)
Unit Endorsement for a Special Event (Temporary) (2, 3, 4, 7, 8 and 9)
The Cancellation of a Unit Endorsement (2, 6, 7, 8 and 9)
2. PERSONAL DETAILS (Complete as shown on passport)
(Completed by the Applicant)
Serial Number of Licence:
Title: ………………….
Surname: …………..…….…………...
Forename(s): …………………………………..……………..
Date of Birth (dd/mm/yyyy): ………………….…………………..
Nationality: ……………..………………………..……………
Place of Birth: ………………………………..……….……………
Country of Birth: ……………………..……………………….
Applicants Address:
………………………………………………..………………..………..………………………………….…
………………………………………………..…………………..……..………………………………….…
………………………………………………..…………………………..……………………………………
County: …………………………. Postcode: ………………… Country: …………………..…………..
Telephone Numbers:
Home: ……………………………………………… Mobile: ………………………………………………
Email Address: ……………………………………………………………………………………………….
Unit Name:
……………………………………….………..………………..………..………………………………….…
Unit Address:
……………………………………….………..………………..………..………………………………….…
…………………………………….…………..………………..………..………………………………….…
County: …………………………. Postcode: ………………… Country: …………………..…………..
ICAO Location Indicator:
The licence will be sent to the unit by default unless specified otherwise by the unit or individual with an explanation
to: ats.licensing@caa.co.uk.
3. NOTIFICATION OF UNIT ENDORSEMENT ASSESSMENT
(Completed by the Applicant)
Location of assessment: …………………………………………. Proposed date (dd/mm/yyyy): ………………………………..
Form SRG 1411B Issue 04, June 2021
Page 1 of 3
4. RATING/ENDORSEMENT TO BE ASSESSED
(Completed by the Applicant)
Unit Endorsement Sector/Position(s) (if appropriate): ………………………………………………………………………………..
Rating
Rating Endorsement
Description
ADV Aerodrome Control Visual:
ADI Aerodrome Control Instrument:
TWR:
Tower Control
AIR:
Air Control
RAD:
Aerodrome Radar
GMC:
Ground Movement Control
GMS:
Ground Movement Surveillance
APP Approach Control Procedural:
APS Approach Control Surveillance:
SRA:
Surveillance Radar Approach
PAR:
Precision Approach Radar
TCL:
Terminal Control
ACP Area Control Procedure:
OCN:
Oceanic
ACS Area Control Surveillance:
TCL:
Terminal Control
OCN:
Oceanic
5. DETAILS OF APPLICABLE RATING TRAINING COURSE
(Completed only when the unit endorsement is for a new rating)
Rating: ………..……… Approved Course completed (dd/mm/yyyy): ……………….. Course number: …………….………..
Name of training organisation: …………………………………………………………………………………………………………..
6. CANCELLATION OF UNIT ENDORSEMENT
(Completed by the Applicant)
Rating/Rating Endorsement/Sector/Operational Position (e.g. ADI/TWR/RAD/GMS/EGXX Tower)
……………………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………….…… Date of cancellation: ………………….
7. DECLARATION BY UNIT
(Completed by the Unit Manager)
I, the undersigned, hereby certify that:
The applicant meets the relevant requirements of Commission Regulation (EU) 2015/340.
The applicant is recommended for a Unit Endorsement Assessment.
Date (dd/mm/yyyy): ................................................................... Signature: ...........................................................................
Surname: .................................................................................. Forenames: ........................................................................
Post held: ..................................................................................................................................................................................
8. FINANCIAL DECLARATION
(MUST BE COMPLETED BY APPLICANT EVEN IF PAYMENT IS MADE BY A THIRD PARTY)
I am applying for the inclusion of Unit Endorsements for new Ratings, existing Ratings including Special Events or for the
Renewal or Cancellation of Unit Endorsements.
I hereby declare that to the best of my knowledge the particulars entered on this application are accurate.
I enclose the charges payable on application in accordance with the Scheme of Charges (www.caa.co.uk/ors5).
I agree to pay any additional charges which may become payable in respect of this application under the Scheme of Charges.
Name of Applicant (as shown in 2): ..........................................................................................................................................
Signature of Applicant (named in 2): ....................................................................................... Date: ....................................
Form SRG 1411B Issue 04, June 2021
Page 2 of 3
9. PAYMENT BY A THIRD PARTY
If payment for this application is not being made by the applicant, this form must be countersigned by the payee.
I, (name) ……………………………………………………………. authorise the Civil Aviation Authority to use the details given
on the attached payment authorisation (FCS1500) in support of this application.
Signature of Payer: ................................................................................................................... Date: ....................................
Address: ....................................................................................................................................................................................
Contact Telephone Number: ......................................................
10. SUBMISSION INSTRUCTIONS
Please check:
• Section 2 (Personal Details) has been fully completed;
• All Sections relevant to the notification have been completed;
• The declaration has been signed by the applicant and the Unit Manager; and
• The correct remittance is included with the application (refer to Section 7 Guidance Notes);
when completed, return to:
Civil Aviation Authority
Aviation House
Beehive Ring Road
Crawley
West Sussex
RH6 0YR
or e-mail to:
ats.licensing@caa.co.uk
Telephone Enquiries: +44 (0)330 022 1972
Form SRG 1411B Issue 04, June 2021
Page 3 of 3
Application for the inclusion of Unit Endorsements for new Ratings,
existing Ratings including Special Events and for the Renewal and
Cancellation of Unit Endorsements in an Air Traffic Controller (ATCO)
Licence
Guidance on completion of CAA Form SRG1411B
Section 1
Type of Application
This form is used for five types of application:
• The application to obtain a unit endorsement for a new rating
• The application to obtain a subsequent unit endorsement for an existing rating
• The application to renew an expired unit endorsement
• The application for a temporary endorsement (Special Event)
• The application to cancel a unit endorsement
Select the type of application in Section 1 and tick the appropriate box. It is then important to ensure all the appropriate
sections of the form indicated in Section 1 are completed.
Section 2
Personal Details
To maintain consistency of personal detail records please ensure the details entered match that on the applicant’s passport.
The Applicants Permanent Address must be the applying ATCO’s address not the unit’s address.
Fully complete the Unit Address and ICAO Locator Indicator code.
Section 3
Notification of Unit Endorsement Assessment
Enter the Location and Proposed date (see below) of the Unit Endorsement Assessment.
The following should be noted;
Where the application is to obtain an Initial Unit Endorsement for a new rating the applicant must be assessed for
competence by a Unit Endorsement assessment board, chaired by a CAA Inspector ATS. Please contact your Regional
Office CAA Inspector ATS to agree dates for the assessment board before submitting this form.
Where the application is for a Subsequent Unit Endorsement for an existing rating or for the Renewal of a Unit
Endorsement that has expired, the applicant must be assessed for competence by a Unit Endorsement assessment board.
Unit Assessors who hold an Assessor Endorsement (Chairman), authorisation letter may, at the discretion of the relevant
Regional Office Principal Inspector be permitted to conduct the assessment board.
At Units that do not have an appropriately authorised assessor, a CAA Inspector ATS will chair the assessment board.
Please contact your CAA Regional Office to obtain permission to chair the assessment board or to arrange for the attendance
of a CAA Inspector ATS as appropriate and in the latter case, agree a date for the assessment before submitting this form.
Where the application is for a Temporary Unit Endorsement, this is usually for a Special Event of limited duration; the
assessment must be carried out by a CAA Inspector ATS.
To allow time for processing, this form should be submitted at least 15 days before the agreed assessment date.
Where a new Rating has to be included on the licence, CAA ATS Licensing will issue a new ATCO licence on receipt of this
form. The licence will contain the details of the Rating/Endorsement being assessed including the expiry date, based on the
proposed assessment date. Should, for any reason, the proposed assessment date have to be amended, notify ATS
Licensing by e mail (ats.licensing@caa.co.uk) of the new date as soon as possible. ATS Licensing will issue a new licence
based on the new assessment date. The old licence is to be returned to the CAA at the address shown in section 10.
Should the unit endorsement assessment be cancelled inform ATS licensing and your CAA Regional Office.
NOTE: COMPLETION OF A UNIT ENDORSEMENT ASSESSMENT MUST BE NOTIFIED TO THE CAA ON FORM
SRG1411D
Section 4
Rating/Endorsement to be Assessed
Tick the appropriate boxes to indicate the Rating and Rating Endorsement, where relevant, to be assessed and enter details
of Sector/Position against the Rating Endorsement if appropriate.
Form SRG 1411B Issue 04, June 2021 Guidance Notes
Page i of ii
Section 5
Details of Rating Training Course
This section must be completed only when a New Rating is to be added to a licence and must detail relevant Initial Training
Organisation course undertaken for the new rating.
Section 6
Cancellation of a Unit Endorsement
This section to be completed only when cancelling a Unit Endorsement.
Details of the Unit Endorsement to be cancelled are to be entered here. On receipt of this form ATS Licensing will issue a
new and appropriately amended licence if the cancelled unit endorsements are within their validity period.
Section 7
Declaration by Unit
Must be completed by the ATS Unit Manager or other senior staff member.
Section 8
Financial Declaration
This must be completed by the applicant.
Section 9
Payment
Certain Air Traffic Service Providers/Training Organisations e.g. NATS, have an ‘Agreed Method of Payment’ with the CAA
that does not require them to complete the Payment Authorisation form FCS1500.
All other organisations must make the appropriate payment by any of the methods shown on form
FCS1500
and send
completed form FCS1500 with the application.
SRG Forms for ATCO Licensing
• SRG1411A:
Application for the Issue of an Air Traffic Controller Licence
• SRG1411B:
Application for the inclusion, renewal or cancellation of Unit Endorsements in an ATCO Licence
• SRG1411D:
Notification of Completion of an Air Traffic Controller (ATCO) Unit Endorsement Assessment
• SRG1411E:
Application for the Notification of a Change to Personal Details to an ATCO or FISO licence or Radio
Operator Certificate of Competence
• SRG1411F:
Application for the Issue of a UK Air Traffic Controller (ATCO) Licence by Holders of an EU Member
State Licence issued in accordance with Regulation (EU) 2015/340
• On-Line Form:
Replace a licence or certificate that has been lost, damaged or stolen
• SRG1415:
Application for the issue, revalidation or renewal of an ATC Assessor, OJTI or STDI licence endorsement
• SRG1416:
Record of Revalidation of an ATCO Unit Endorsement
• SRG1421:
Application for the Issue of a Student Air Traffic Controller License or the inclusion of Additional Ratings
• SRG1426:
Air Traffic Controller Licence - Revalidation or Renewal of an English Language Proficiency
Endorsement
Form SRG 1411B Issue 04, June 2021 Guidance Notes
Page ii of ii
Page of 5