Form Approved: OMB No. 2120-0607 06/30/2007 NATIONAL DRIVER REGISTER RECORDS REQUEST (PRIA) Pilot Records Improvement Act Of 1996 (PRIA) Title 49 U.S.C. § 44703(h), RECORDS OF EMPLOYMENT OF PILOT APPLICANTS, as amended Pursuant to 49 U.S.C. § 44703(h)(5), the NDR, as a person who receives a request for records under 49 U.S.C. § 44703(h)(1)(C), shall furnish a copy of the requested NDR records concerning all applicants, not later than 30 days after receiving the request. PART I: NATIONAL DRIVER REGISTER (NDR) RECORDS REQUEST This request authorizes the National Highway Traffic Safety Administration (NHTSA) to perform a one-time file search of the National Driver Register (NDR) for information pertaining to me, and to provide the results to the prospective employer listed below. This search is to be limited to information about revocations or suspensions still in effect on the date of the request or information entered into the NDR in the past 5 years from the date of the employment application. Upon my written request, the prospective employer listed below shall make available to me any NDR information received as a result of this search. _______________________________________________ , (Air Carrier Name) ________________________ , hereby requests records pertaining to: (Air Carrier Certificate #) ____________________________________ , ___________________________ , _____________________________ (Full Legal Name – first, middle, last) (Date Of Birth) (Social Security Number – optional) ________________________________________________________________________________________________ (Other Names Used – maiden prior name, nickname, professional name, other. If none, enter 'none') ______________________________________ , _______ , _______________ , _______________ , _____________ (Driver License Number and State) (Gender) (Eye Color) (Height) (Weight) ________________________________________________________________________________________________ (Mail the completed report to the requesting air carrier at this address) PART II: CONSENT TO THE RELEASE OF RECORDS Prospective Employee Understanding: I understand that the National Driver Register (NDR) search will result in a printed report, which shall be sent only to the prospective employer listed on this form. The report will indicate either: (1) that the NDR does not contain a records matching my identification; or, (2) that the NDR has a probable identification (pointer record) from one or more states, which will be named on this report. A separate and additional check of state files, as a result of the pointer record, would be required: (1) to verify the identification; or, (2) to obtain the driving record. Under the Privacy Act, I have the right to request records pertaining to me from the NDR to verify their accuracy. With my notarized signature, (If notarization is required) I hereby authorize a one-time file search of NDR related records pertaining to me, with any and all resulting reports to be sent to the prospective employer named in Part I of this form. __________________________________________________________________ (Signature Of Applicant) ______________________________ (Date Of Signature) PART III: NOTICE TO THE PROSPECTIVE EMPLOYEE Pursuant to Title 49 (U.S.C.) § 44703(h)(6) Records of Employment of Pilot Applicants, as amended, you are hereby notified, by being provided with a completed copy of this form, that the above air carrier will submit an FAA Records Request (PRIA) for your NDR related records. You are also notified of your right to receive a copy of any and all such records furnished by the NDR. III(a). For Official ID Verification Date Sent: Internal Control: Date Received: ___Valid Photo Driver License ___State Issued Photo ID ___Birth Certificate ___Valid Passport ___Valid Military ID ___Military Discharge ___Other ___________________________________________ (Indicate the specific type of identification used.) ___________________________________________________ Printed name and signature of person verifying identification. III(b). Notarization Required only if the NDR File Check Request is NOT made in person by the prospective employee, or by the respective state. Sworn to and ascribed before me this_____day of __________ In the city/county of_______________________state of_____ Signature of Notary Public_____________________________ Notary Public Seal: FAA Form 8060-13 (10-05) American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS FAA FORM 8060-13, NATIONAL DRIVER REGISTER RECORDS REQUEST (PRIA) Pilot Records Improvement Act Of 1996 (PRIA) Title 49 U.S.C § 44703(h), RECORDS OF EMPLOYMENT OF PILOT APPLICANTS, as amended Air carriers should use this form to request the appropriate records from the National Driver Registry as contemplated under 49 U.S.C. § 44703(h). Complete Instructions for the use of this form, as well as procedural information concerning the request of NDR records, are provided on the official PRIA website as listed below. NOTICE Request will not be deemed valid unless Parts I, II, and III are completed as specified below. This form may be photocopied for use. This form is available on the Internet at www.faa.gov/pilots/lic_cert/pria or http://forms.faa.gov/ A separate form must be used for each airman whose records are requested. Use of the date of birth, social security number, or other information for which there may be a reasonable expectation of privacy, is optional. However, use of this information, at the applicant’s discretion, could facilitate the retrieval of the appropriate records required by this request IAW PRIA. (See the Privacy Act Statement) Part I – National Driver Register (NDR) Records Request: To be completed by the hiring Air Carrier. All entries must be completed legibly with black or dark blue ink. The hiring air carrier enters their name and air carrier certificate number. Personal information concerning the applicant is then entered into the respective spaces, with the date-of-birth and social security number being disclosed ONLY at the discretion of the applicant. The air carrier must ensure that complete mailing instructions are included with this request. Part II – Consent To The Release Of Records: To be completed by the applicant. All entries must be completed legibly with black or dark blue ink. The applicant must read and understand the statement, and then authorize the request and release of the appropriate NDR records by signing and dating the form in the indicated spaces. A notarized signature MAY be required by the state. Part III – Notice To The Prospective Employee. The air carrier representative must ensure that the applicant is aware that a request for the appropriate NDR records will be made IAW PRIA, and that a copy of the records, once received, will be furnished to the applicant if they so desire. A legible copy of this form must be furnished to the applicant after being completed and signed. ID verification in III(a) is to be completed by the air carrier representative when the application is made in person. ID verification in III(b) is to be completed when the application is NOT made in person. The respective state MAY also require a notarized signature. PAPERWORK REDUCTION ACT STATEMENT Title 49 United States Code (49 U.S.C.) § 44703(h), Records of Employment of Pilot Applicants, as amended, requires all air carriers to request FAA records and Air Carrier and Other Records concerning an individual before allowing that individual to begin service as a pilot. 49 U.S.C. § 44703 (h)(8) requires the FAA Administrator to promulgate standard forms to request records. The information entered on the standard forms will be used to facilitate the search and retrieval of the required records. It is estimated that the average burden per respondent associated with this collection of FAA Records is 10 minutes. The requirement to collect and evaluate background information on the pilot, before allowing that pilot to begin service, is mandatory; however, the use of this form is not, although it is highly recommended. An agency may not conduct or sponsor, and a person is not required to respond to, this request for information unless a current and valid OMB control number is prominently displayed. The OMB control number assigned to this collection is 2120-0607. Comments concerning the accuracy of this burden and suggestions for reducing the burden should be directed to the FAA at: 800 Independence Ave. SW Washington, DC 20591, Attn: Information Collection Clearance Officer, ABA-20 PRIVACY ACT STATEMENT The information on the accompanying form is solicited under the authority of Title 49 U.S.C. § 44703, Records of Employment of Pilot Applicants, as amended. The purpose of this data is to be used to determine the suitability of a pilot applicant being considered by an air carrier for employment. The routine use of this information, after the request has been completed, allows a hiring air carrier to evaluate the professional competence and suitability of a pilot applicant, before extending a firm offer of employment to that pilot. Submission of the DOB and SSN is voluntary; however, the disclosure of the DOB and SSN could facilitate the retrieval of the appropriate records which are usually maintained in alphabetical order and/or cross-referenced with the airman certificate number and/or SSN. Failure to disclose the SSN could result in a delayed, incorrect, or negative response to this request, caused by the possible misidentification of the records, or the failure to identify the appropriate records of the person who is the subject of this request. FAA Form 8060-13 (10-05) American LegalNet, Inc. www.FormsWorkflow.com