158-aircraft-dispatcher-instructor-authorization-issuance-and-renewal-application

gaca_gov_sa · form · processed · 3 chunks

GACA
الحييه العامه لطيران المدني
General Authority of Civil Aviation
[Non-Text]
AIRCRAFT DISPATCHER INSTRUCTOR AUTHORIZATION ISSUANCE/RENEWAL
APPLICATION FORM
<table><tr><td colspan="11">Dispatcher Instructor Authorization is Valid for 3 Years From the Date of Issuance or Renewal</td></tr><tr><td colspan="11">FOR APPLICANT USE ONLY</td></tr><tr><td colspan="11">1. Organization Details, if applicable.</td></tr><tr><td colspan="11">Name of the Organization</td></tr><tr><td>Type of Organization</td><td colspan="2">☐ 141</td><td>☐ 142</td><td>☐ 143</td><td>☐ 121</td><td>☐ 135</td><td colspan="4">☐ 125</td></tr><tr><td>Address</td><td colspan="10"></td></tr><tr><td>Contact Number</td><td colspan="10"></td></tr><tr><td rowspan="2">Heads of Training Details</td><td colspan="3">Name</td><td colspan="3">Email</td><td colspan="4">Phone No.</td></tr><tr><td colspan="3"></td><td colspan="3"></td><td colspan="4"></td></tr></table>
<table><tr><td colspan="2">2. Flight Dispatcher Instructor Details</td></tr><tr><td>Applicant Name</td><td></td></tr><tr><td>Date &amp; Place of Birth</td><td>License Expiry Date</td></tr><tr><td>I am applying for Aircraft Dispatcher Instructor Authorization hereby declare that the information given in this form is true &amp; correct</td><td>□ Authorization Issuance □ Authorization Renewal</td></tr><tr><td>Applicant Signature</td><td></td></tr></table>
<table><tr><td colspan="2">3. Aircraft Dispatcher Instructor Authorization Issuance Requirements</td><td colspan="2">Compliance</td></tr><tr><td>No.</td><td>Requirements</td><td>Yes</td><td>No N/A</td></tr><tr><td>a</td><td>Hold an aircraft dispatcher certificate issued under GACAR Part 65 or CPL under 61.</td><td>□</td><td>□ □</td></tr><tr><td>b</td><td>Have at least 2 years&#x27; experience as an aircraft dispatcher or Pilot in any operation conducted under GACAR Part 121 or Air Commercial Operations;</td><td>□</td><td>□ □</td></tr><tr><td>c</td><td>Have previous instructing experience;</td><td>□ □</td><td>□ □</td></tr><tr><td>d</td><td>Must satisfactorily demonstrate his knowledge and proficiency of each curriculum that he is designated to provide instruction;</td><td>□ □</td><td>□ □</td></tr><tr><td>e</td><td>Successfully completed a course on instructional techniques/Train The Trainer (initial/recurrent);</td><td>□ □</td><td>□ □</td></tr><tr><td></td><td>Training in knowledge and skills related to human factors principles must be included in both initial and recurrent instructor training.</td><td>□ □</td><td>□ □</td></tr><tr><td>f</td><td>For 121, 135, or 125 (if applicable), complete operator internal training concerning the applicable manuals (OM), administrative procedures, contents of training manuals, system, process, procedures, training related documents, forms, and records in accordance with training manual.</td><td>□ □</td><td>□ □</td></tr><tr><td>G</td><td>Successfully completed skill level assessment through demonstration lecture and interview by GACA/Flight Operations ASI(s)</td><td>□ □</td><td>□ □</td></tr></table>
<table><tr><td colspan="2">4. Aircraft Dispatcher Instructor Authorization Renewal Requirements</td><td colspan="2">Compliance</td></tr><tr><td>No.</td><td>Requirements</td><td>Yes</td><td>No N/A</td></tr><tr><td>a</td><td>Applicant must meet all the issuance requirements; and</td><td>□ □</td><td>□ □</td></tr><tr><td>b</td><td>Completed Aircraft dispatcher recurrent training within the preceding 12 months. (annual recurrent training).</td><td>□ □</td><td>□ □</td></tr></table>
<table><tr><td colspan="4">5. 5. Accountable Manager/Executive DeclarationI hereby certify that applicant meets the Requirements for Aircraft Dispatcher Instructor Authorization□ Issuance□ RenewalI have checked the applicant record, this application attachments and I am satisfied that the information contained in this application is true, correct and completed</td></tr><tr><td>Name</td><td>Signature</td><td>Date</td><td></td></tr><tr><td></td><td></td><td></td><td></td></tr></table>
GACA-AVSES-OPS-F158
Rev: 3, Date: 27 Oct 25
Page 1 of 3

GACA
العربيه العامه للطيران المدني
General Authority of Civil Aviation
[Non-Text]
AIRCRAFT DISPATCHER INSTRUCTOR AUTHORIZATION ISSUANCE/RENEWAL
APPLICATION FORM
FOR GACA USE ONLY
<table><tr><td colspan="4">1. Assessor Designation</td></tr><tr><td colspan="4">The undersigned, Chief of Training Section authorizes xxx to conduct skill level assessment for the Aircraft Dispatcher Instructor Authorization through lecture demonstration and interview</td></tr><tr><td>Name</td><td>Signature</td><td colspan="2">Date</td></tr><tr><td></td><td></td><td colspan="2"></td></tr><tr><td colspan="4">2. Assessor/DADE Recommendation</td></tr><tr><td>Lecture and Interview Date</td><td>Skill Level Assessment</td><td>□ SAT</td><td>□ UNSAT</td></tr><tr><td colspan="4">Remarks</td></tr><tr><td colspan="2">Assessor Name</td><td>Signature</td><td>Date</td></tr><tr><td colspan="2"></td><td></td><td></td></tr><tr><td colspan="4">3. GACA Flight Dispatcher Instructor Authorization Approval</td></tr><tr><td>Authorization Application</td><td>□ Authorization Issuance</td><td colspan="2">□ Authorization Renewal</td></tr><tr><td>Authorization Issue</td><td>□ Approved</td><td colspan="2">□ Not Approved</td></tr><tr><td>Authorization Privileges</td><td colspan="3">Exercise the privilege of conducting Aircraft dispatchers:□ Initial training□ Basic indoctrination training□ Transition training□ Differences training□ ETOPS initial training□ Requalification training□ Annual recurrent training and checking</td></tr><tr><td>Authorization Expiry Date</td><td colspan="3"></td></tr><tr><td colspan="4">Remarks</td></tr><tr><td colspan="2">Inspector Name</td><td>Signature</td><td>Date</td></tr><tr><td colspan="2"></td><td></td><td></td></tr></table>
GACA-AVSES-OPS-F158
Rev: 3, Date: 27 Oct 25
Page 2 of 3

GACA
ال necesita للطيران المدني
General Authority of Civil Aviation
[Non-Text]
AIRCRAFT DISPATCHER INSTRUCTOR AUTHORIZATION ISSUANCE/RENEWAL
APPLICATION FORM
SUPPORTING DOCUMENTS
• Cover Letter from the organization for Flight Dispatcher Instructor Authorization issue/renewal, if required;
• This application form;
• Aircraft Dispatcher Instructor assessment checklist;
• Copy of flight dispatcher license or Pilot's License (at least CPL);
• Copy of the current/expired Aircraft Dispatcher Instructor Authorization – renewal only
- Prove of the working experience as an Aircraft Dispatcher or Pilot in commercial air transport;
- Copy of the instructional techniques/Train the Trainer training course completion certificate – for issuance only
- Prove of Aircraft dispatcher Instructor initial training – for issuance.
- Prove of Recurrent training within the authorization period validity (12 calendar months preceding the expiry date) – renewal only; or
- Prove of attending flight dispatcher recurrent training – renewal only
• Copy of valid passport/ID – issue only;
- One photo
GACA-AVSES-OPS-F158
Rev: 3, Date: 27 Oct 25
Page 3 of 3