Candidate Questionnaire & Declaration

RISHWORTH AVIATION/IBEX: CANDIDATE QUESTIONNAIRE & DECLARATION

___________________________________________________________________

Thank you for your application to Rishworth Aviation!

We look forward to supporting you with your application to IBEX. This document is required to be
completed as part of the application process to ensure that we fully understand your current employment
situation, background and experience with a view to maximising your opportunities with our airline clients.

We are here to help you throughout this process.

Please don’t hesitate to contact anyone of our Recruitment Consultants at any time.
____________________________________________________________________________________

INFORMATION IN SUPPORT OF APPLICATION:

Please provide further details/explanation regarding your work history, including flying and non-flying
positions. This is to provide the airline with an overall understanding of your background and experience:

If you have any gaps of 3 months or more in your work history, please note what you were doing during
this time.

Please include any other details such as your training, any non-flying jobs, and reasons for leaving
airline/position.

I have more than 6 years of work experience in the aviation industry more specific, airline experience.
I have logged 3600hrs of total flight time to this day.
I have worked in many different areas of the industry as general aviation, ground and flight instruction
and regional airlines.
I have been working as an airline pilot for over 6 years.
Now I am currently rated as a Pilot in command of the CRJ 200 aircraft flying for a government owned
regional company in Bolivia.

I would remark my CRM and ADM, the ability to perform well under pressure, risk management
assertively, and patience towards other members of the flight or cabin crew, also being able to integrate
positively other parts involved in the operation of an airline.
I am available for interviews and would be able to relocate as fast as 3 months from the moment I have a
job confirmation.

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Training Resume

BoA- Boliviana de Aviacion- Airline SEPTEMBER 2018- PRESENT

Recurrent Training PIC CRJ200 Phoenix AZ-USA MAY 2019
Recurrent Training PIC CRJ200 Phoenix AZ-USA OCTOBER 2018
AMASZONAS Airline JANUARY 2015- JULY 2018
Recurrent Training PIC CRJ200 Phoenix AZ-USA MARCH 2018
Recurrent Training PIC CRJ200 Phoenix AZ-USA AUGUST 2017
Bombardier Regional Jet- UPGRADE Training Phoenix AZ-USA&CHARLOTE NC- USA
CAE-American Airlines Training Center SEPTEMBER 2016
Recurrent Training SIC CRJ200 Phoenix AZ-USA MARCH 2016
Bombardier Regional Jet- Line Training La Paz-BOL
Bombardier CRJ200- Ground & Initial Training
Pan Am International Flight Academy Minneapolis MN-USA MARCH 2015
AEROCON Airline FEBRUARY 2013- JANUARY 2015
Metro liner Ground School & Line Training Santa Cruz-BOL
Flight Schools CFI FEBRUARY 2012- FEBRUARY 2013
AEROSUR Airline FEBRUARY 2011- DECEMBER 2011
Boeing 737-200 SIC Initial Training
Pan Am International Flight Academy Miami FL-USA JULY-2011

SECTION 1: GENERAL

1.1 Do you have any questions about the contract terms?

Yes No X

If Yes, Please specify:

1.2 Do you have any experience working/flying in Japan?

Yes No X

If Yes, Please say when:

1.3 Is IBEX your first preference?

Yes X No

If No, Please provide details:

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SECTION 2: PREVIOUS APPLICATIONS

2.1 Have you ever applied for a position through Rishworth before?

Yes X No

If Yes, which positions have you applied for through Rishworth?

Last year I applied for IBEX through Rishworth, but was not selected to attend the screening.

2.2 Have you ever been on assignment/contract with Rishworth before?

Yes No X

If Yes, what contract/s and when?

2.3 Have you ever applied to IBEX before (including through any Agency)?

Yes No X

If Yes, Please provide date of application/s:

2.4 Have you ever screened/interviewed with IBEX before (including through any Agency)?

Yes No X

If Yes, Please provide date and location of screening:

What was the outcome of that screening?

Successful Unsuccessful

SECTION 3: MEDICAL and FLYING HISTORY:

3.1 Have you ever had an aviation medical certificate denied, suspended or revoked by any licencing
authority?

Yes No X

If Yes, Please provide details:

3.2 Do you currently, or have you previously had any medical or health concerns or conditions?

Yes No X

If Yes, Please provide details:

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3.3 Have you ever had any form of surgery (including eye surgery)?

Yes No X

If yes please advise what type of surgery you had, when you had that surgery and whether you
have fully recovered:

3.4 Do you suffer from any degree of colour blindness?

Yes No X

Please note: If you are unsure as to whether you suffer from any level of colour blindness, we
recommend that you have this tested before proceeding with any application for Japan.

3.5 Please advise your current BMI: 22.3

Please note: We recommend that your BMI be less than 30.

3.6 Have you ever failed a proficiency assessment/checks (initial training proficiency check, simulator
re-currency check or line check)?

Yes No X
If Yes, Please provide details: Include number and types of checks failed.

3.7 Have you ever been involved in any aviation related incidents or accidents (including during initial
flight training) or are you currently under investigation for an aviation related incident or accident?

Yes No X

If Yes, Please provide details:

3.8 Have you ever been asked to leave an airline or been the subject of an airline disciplinary review
or investigation?

Yes No X

If Yes, Please provide details:

3.9 Have you ever been convicted of a criminal offence, or have any legal actions pending?

Yes No X

If Yes, Please provide details:

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3.10 What Airline are you currently flying for?

Name of current airline:

Boliviana de Aviacion- BoA

3.11 Please let us know why you are considering another airline at this time.

Reason for Leaving: a) Please provide a detailed explanation for your reason for leaving.
b) If you are on a Leave of Absence or Furlough, please provide the details of
these arrangements (timeframe, recall terms) OR advise if you will resign
before starting a new contract.
I am looking for an opportunity abroad in order to seek new personal goals in my
career as a pilot, also looking for more stability with better conditions for my life
which will enable me to provide these better conditions to my loved ones.

I will resign before starting a new contract

3.12 What period of notice are you required to provide your current airline?

Notice period:

1 Month

Earliest date available to start contract:

December 2019

3.13 Do you have any bonding or financial obligations to any airline?

Yes No X

If Yes, Please provide details:

3.14 Please confirm what rank you are, and what your present flying status is (please tick as relevant
and advise the fleet/dates):

Captain/PIC’s First Officers

Flying as Captain/PIC X Flying as First Officer
(do not tick if flying as
Cruise/Relief Captain)
Fleet: CRJ200 Fleet:

Flying as Cruise/Relief Captain Flying as Second Officer

Fleet: Fleet:

If not flying as Captain/PIC, If not flying as First Officer,

please advise the date you last please advise the date you last
flew as Captain/PIC: flew as First Officer:

Fleet: Fleet:

If not flying as Relief/Cruise If not flying as Second Officer,

Captain, please advise the date please advise the date you last
you last flew as Relief/Cruise flew as Second Officer:
Captain:

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Fleet: Fleet:

3.15 If you are not currently flying, what airline did you last fly for and what was the reason for leaving?

Name of airline you last flew for and reason for leaving:

3.16 If you are not currently flying, what have you been doing since your last flying job?

Please explain:

3.17 If accepted by IBEX are you able to commit to the full term of the contract (4+ years)?

Yes X No

If No, Please explain:

SECTION 4: REFEREE DETAILS:

Please provide the contact details of at least 2 referees and if you have worked for more than 1
airline over the last 7 years, please ensure that you provide at least 1 referee from each airline
who can confirm your employment/dates/hours at the airline and were your immediate supervisors
– including your current airline* (Director of Operations, Chief Pilot, Manager/Superior, Post
Holder).

Please supply the airline’s flight operations office number or the office number of the
location where the referee is stationed, and the referee’s company email address.

1. Referee Contact details:

Name: Fernando Perez Company phone number:+59172574454

Position: Simulator/ Line instructor Company email address:

Company: Amazonas fperez@amaszonas.com

2. Referee Contact details:

Name: Fridel Hochaeuser Company phone number: +59171596781

Position: Former Operations manager Company email address:

Company: Amaszonas fhochhaeuser@amaszonas.com

3. Referee Contact details:

Name: Gustavo Quiroga Company phone number: +59172700731

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Position: Intructor Chief Company email address:

Company: BoA gustavo.quiroga@boa.bo

*Tick this box if you do not wish us to contact your current airline/manager until a
job offer has been accepted by you. Please note that after a job offer has been accepted
by you and prior to starting on contract, Rishworth and the airline will make contact with
necessary persons to verify your flight experience and background.

SECTION 5: DECLARATION and CONSENT:

I, the undersigned confirm and declare that:

 All information provided by me in this questionnaire and any documentation I provide to Rishworth
and the Airline is complete and accurate and I understand and acknowledge that any
misrepresentation or falsification may lead to termination of the application process or any
agreement between myself and Rishworth and the Airline; and

 I understand that Rishworth will contact any of the referees provided and will carry out checks in
respect of any documentation or information provided including contacting any airline or persons
necessary to verify my experience, qualifications, records or the information contained in my
application, and I consent to all such checks and to the disclosure of information provided in
relation to my application.

Oscar Raul Vargas Prada Bolivian 4760779

Name Nationality Passport Number

_ ___ __02/08/2019_____
Signature Date

Thank you for taking the time to complete this form. We will be in contact with you
about your application soon. In the meantime, please do not hesitate to contact us
should you have any questions or queries about the application process

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