APPLICATION FORM All Information You Furnish Is Treated in Confidence and Will Not Be Used Without Your Permission

APPLICATION FORM All information you furnish is treated in confidence and will not be used without your permission. Ensure that your employment record is continuous. If the space allowed for any question is insufficient please use a separate sheet. Please print (No hand writing) NOTE: Follow the instructions and format EXACTLY as describe or Air Japan staff will disqualify your application. SURNAME : Doe

FORENAME(S) : John Paul

If you have name in Chinese/Japanese character, please print. DATE OF BIRTH (DD/MM/YY) : 01/02/80

HEIGHT (Centimetres) : 176 WEIGHT (Kilograms) : 82

POSITION APPLYING FOR ; CAPTAIN, F/O

PASSPORT DETAILS The Issue and Expiry date should be the same with attached copy. PASSPORT NO 1 NA569825 PASSPORT NO 2 COUNTRY USA COUNTRY (DD/MM/YY) (DD/MM/YY) DATE OF ISSUE 09/02/17 DATE OF ISSUE (DD/MM/YY) (DD/MM/YY) DATE OF EXPIRY 09/02/16 DATE OF EXPIRY

CONTACT DETAILS PERMANENT ADDRESS TEMPORARY ADDRESS 12 Main Street

CITY Springfield CITY STATE N/A STATE ZIP CODE 91234 ZIP CODE COUNTRY USA COUNTRY TELEPHONE +1 415 522 8444 TELEPHONE FAX NO +1 415 522 8444 FAX NO MOBILE +1 23456789 MOBILE E-MAIL 1 [email protected] E-MAIL 1 E-MAIL 2 N/A E-MAIL 2

LICENCE ATPL LICENSE 1 (Current Licence) ATPL LICENSE 2 NUMBER 123456 NUMBER A320 COMMAND COMMAND TYPE RATINGS TYPE RATINGS

COUNTRY OF ISSUE USA COUNTRY OF ISSUE (DD/MM/YY) (DD/MM/YY) DATE OF ISSUE 26/08/13 DATE OF ISSUE (DD/MM/YY) (DD/MM/YY) DATE OF EXPIRY Perpetual DATE OF EXPIRY (DD/MM/YY) (DD/MM/YY) INSTRUMENT RATING 26/08/13 INSTRUMENT RATING (DD/MM/YY) (DD/MM/YY) DATE OF EXPIRY Perpetual DATE OF EXPIRY (DD/MM/YY) (DD/MM/YY) Radio ISSUE 20/04/94 Radio ISSUE ICAO English Level 5 ICAO English Level (DD/MM/YY) (DD/MM/YY) DATE OF LAST MEDICAL 25/05/13 DATE OF LAST MEDICAL (DD/MM/YY) (DD/MM/YY) DATE OF EXPIRY OF MED DATE OF EXPIRY OF MED 22/06/14 Be sure that you have the right Version (AUG 2017) OLD Versions will not be accepted. AUG2017 EMPLOYMENT HISTORY (If the space allowed is insufficient use a separate sheet) FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING: 10/13 Present Pacific USA Airlines 7000USD Job Advancement

SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE: Captain A. America 12 Boeing Drive, Los Angeles Airport, California, USA +415 333 4444

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY): A320 First Officer 892:42 10/13 Present

FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES: DATE: TIME: YES / NO FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING: 01/11 09/13 West Pacific Airlines 6000USD Airline Bankrupt

SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE: Captain K. F See 20 Airbus Street, Seattle Airport, Washington, USA +360 123 5555

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY): A320 First Officer 1575:24 01/11 09/13 A321 First Officer 171:54 01/11 09/13

FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES: DATE: TIME: YES / NO FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING: 11/08 09/10 Acme Air 2000USD Hired by West Pacific

SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE: Captain Iran Jaya Jalan Merdeka 300, Pangandaran, West Java, 444444, Indonesia +62 2234 56780

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY): C208 Captain 597:36 12/09 09/10 C208 First Officer 630:18 11/08 11/09

FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES: DATE: TIME: YES / NO FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING:

SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE:

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY):

FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES: DATE: TIME: YES / NO FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING:

SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE:

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY):

FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES: DATE: TIME: YES / NO

AUG2016 GENERAL AVIATION and NON-Aviation Employment History FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING: 03/08 10/08 Chevron Aviation 500USD This was a part time job to support me during flight training. I left when Acme Air offered me a position. SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE: Mr H Burger 1234 Main Street, San Francisco, California, USA +1 415 345 6789

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY): N/A Fueler N/A 03/08 10/08

FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES: DATE: TIME: YES / NO FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING: 12/05 10/08 Taco Bell 500USD This was a part time job to support me while I was at University SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE: Mr. B Bio 1234 Kirk Street, San Francisco, California, USA +1 415 345 9999

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY): N/A Cook N/A 12/05 10/08

FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES: DATE: TIME: YES / NO FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING:

SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE:

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY):

FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES: DATE: TIME: YES / NO FROM(MM/YY) TO(MM/YY) COMPANY Currency / Salary(MONTH) REASON FOR LEAVING:

SUPERVISOR: ADDRESS, CITY, STATE, ZIPCODE: PHONE:

AIRCRAFT(S): DUTY / POSITION FLT TIME: FROM(MM/YY): TO(MM/YY):

FOR OFFICE USE ONLY: NAME: DISCREPANCY(IES): NOTES: DATE: TIME: YES / NO

TRAINING Back Ground Information (Advice ALL Information required) *Advice when and where you earned below:- (MM/YY) (COUNTRY) (PLACE / CITY) (Memo / Notes) PPL 03/12 USA Central Aviation Training Centre, Florida (MM/YY) (COUNTRY) (PLACE / CITY) (Memo / Notes) CPL 09/14 USA Central Aviation Training Centre, Florida (MM/YY) (COUNTRY) (PLACE / CITY) (Memo / Notes) MEL 09/14 USA Central Aviation Training Centre, Florida (MM/YY) (COUNTRY) (PLACE / CITY) (Memo / Notes) IR 06/09 USA Central Aviation Training Centre, Florida (MM/YY) (COUNTRY) (PLACE / CITY) (Memo / Notes) ATPL 06/09 USA Central Aviation Training Centre, Florida AUG2016 PERIODS OF UNEMPLOYMENT Please account for any periods of unemployment of at least 30 days FROM(MM/YY) TO(MM/YY) REASON 03/13 05/13 Between Aviation Contracts

INSTRUCTOR QUALIFICATIONS

TRAINING QUALIFICATIONS AIRCRAFT AIRLINE (Line/Base/Ground/Sim etc) None None None

FLYING EXPERIENCE FMS Equipped TOTAL TIME DATE OF LAST Glass INSTRUCTOR FLIGHT AIRCRAFT Cockpit TIME Command Co-Pilot (DD/MM/YY) Yes No Time (P1) Time(P2) DUAL *including SOLO *Including PUS A321 171:54 12:06 05/07/13 A320 2468:06 20/10/14 C208 597:36 611:48 177:42 22/09/10 BE76 24/09/10 C172 88:48 28/03/12

1. When entering aircraft type please specify aircraft series (e.g. B737-200/B737Efis, B747/B747-400) 2. Command (P1) time does not include Cruise Captain time or P1u/s time 3. Do not include Simulator time in flight times

TOTAL TIME: 4128:00 TOTAL JET TIME*: 1027:30 JET P1: 00:00 Dual Time can be less TTL P1 (with Solo): DUAL TIME: JET P2: 686:24 189:48 than in your logbook. 2640:00 TTL P2 (with PUS): 3251:48 / (*PUS: 487:32 ) TOTAL B757/B767 TIME: 00:00

INSTRUMENT TIME: 102:30 EFIS: 2640:00 NIGHT FLIGHT TIME : 1027:24 CROSS COUNTRY TIME: 3968:36 CROSS COUNTRY PIC TIME: 641:30 *CROSS COUNTRY PUS TIME: 128:24 Commercial Jet time only-Do not include Helicopter time Total Time = TTL P1 + TTL P2 + Dual Time (TTL P1 and TTL P2 must match your logbook. Dual Time can be less than your logbook since the JCAB does not concurrently log PIC and Dual after receiving your PPL. Dual Time is the only exception, all *PUS = P1US, ICUS time other flight times must match your logbook copies submitted. *Cross Country PUS Time must be put when Cross Country PIC time is less than 100H

CURRENCY RECORD

TOTAL FLYING HOURS IN LAST 6 AIRCRAFT TYPE: A321 P1: 0:00 P2: 142:06 MONTHS

DATE OF LAST PROFICIENCY CHECK ; 01/17, A/C TYPE ; A321, RENEWAL ; 01/18. DATE OF LAST INSTRUMENT RATING ; 12/16, A/C TYPE ; A321, RENEWAL ; 12/17.

AUG2016 ACCIDENTS/INCIDENTS/ATC VIOLATIONS

Give details of any A/C accidents, incidents or ATC violations in which you have been involved: None

BACK GROUND INFORMATION Have you ever been convicted of a criminal offence in a court of law? If yes give details. Yes / No (If Yes, give details:)

Have you ever been convicted of a violation of any Federal or State Statute for DUI/DWI? Yes / No (If Yes, give details:)

CURRENT EMPLOYMENT STATUS If you are currently employed, how are you planning to work for AJX ?

1. Resign from current position 2. Apply for LOA 3. Currently furloughed 4. Currently unemployed

If your answer is 2 or 3, what is the maximum period of time you can apply for ?

AVAILABILITY FOR EMPLOYMENT / NOTICE TERM

When could you start training if offered position? How long is your notice of resignation to current employer? Please answer available date (DD/MM/YYYY) or notice term. 2 Months

COMMUTING DETAILS

If offered position, from which country and city are you planning to commute to Japan? Los Angeles, USA If the above commuting city is outside Asia or Oceania, are you willing to relocate if necessary? If so, where can you relocate? Brisbane, Australia

EXPERIENCE OF OTHER AIRLINES APPLICATION Have you ever applied for ANA Group Companies (Air Japan/ANA & JP Express/ANK/ANA WINGS) previously? YES NO

If yes, which company? Air Japan ANA & JP Express ANK ANA WINGS/A-net Yes, I underwent screening process in / ( mm / yy ) , which was successful / unsuccessful Have you ever applied for Japanese airlines previously? (i.e. JAL, JALways, JAL express, NCA, AirDo, Skymark, StarFlyer, IBEX, Solaseed, Peach & etc.) YES NO Company name : Only check YES if you actually attended a screening with the airline. Yes, I underwent screening process in / ( mm / yy ) , which was successful / unsuccessful

DECLARATION I certify that this application is true and correct to the best of my knowledge and that if any falsification is found this will be ground for termination of application process or agreement with written notice having immediate effect.

Signed : John Doe , Date : 13/04/2017 .

AUG2016 Autobiographical & Other Relevant Information

(This section should include further relevant information in regards to your application not covered in the attached application form. This information can cover such topics as; work experience, management experience, explanation for resigning from previous employers, further information on any accidents or incidents, hobbies and interests etc)

Applicant Name: John Paul / Doe Applying For ; Captain / First Officer

A short introduction on who I am: I grew up in Canada and moved to the USA as a teenager. I am married, with no children, and in my spare time I enjoy travelling, playing sports such as golf, tennis and football, reading and spending time with family and friends.

Being a pilot was always my dream growing up - at the age of Six a friend of my father took us up in a Piper Archer and I was hooked on flying. After high school I attended University where I completed a Bachelor of Commerce degree, majoring in Finance, and after completing my studies I began flight training at Airworthy Flying School in Napa Valley. Here I gained a PPL, CPL and multi-engine instrument rating.

My first job was with a charter company called Acme Air, carrying passengers and cargo throughout Indonesia. I spent two years in Indonesia and during that time I completed the USA ATP subjects via distance learning. In 2010 I interviewed with West Pacific Airways for a position as a pilot and was offered a job shortly afterwards. I spent two months in Miami, completing an A320 type rating course and carrying out line training before starting with West Pacific Airways in January 2011. Based in Seattle, I flew the Airbus A320 and A321, and in October 2013 I changed Airlines to Pacific USA Airways, flying the A320 based in Los Angeles. A highlight of my time at Pacific USA was being selected to teach CRM to Pilots and Cabin Crew.

I first heard about Air Japan when I was talking to a former employee of the airline in a hotel lobby in Las Vegas. He had many positive things to say about Air Japan and encouraged me to apply for a First Officer position. Later, I met Ronald Macdonald, a Captain at Pacific USA who spent many years with Air Japan, and he too had many positive things to say about the company. I am attracted by the opportunity to fly the Boeing 767, to experience life in Japan and to use the days off to travel with my wife. I have spent many hours talking to my family and friends about applying for this position and they are all highly supportive of my application. I am very keen on joining your company and having recently finished a bond period at my current airline, Air Japan is the first and only airline I have applied to.

A First Officer position at Air Japan is highly desirable to me, and I believe I have the abilities and personal qualities you are looking for in a pilot. I appreciate your consideration of my application and I look forward to interviewing with you.

Kind Regards, John Doe

AUG2016