2. Operativni detalji dostavljeni uz zahtjev Operational Details to be provided to the Agency with the application Da / Yes Ne / No
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1 Napomena: Popunite velikim slovima bijela polja, označite sa X odgovarajuće kvadrate Remark: Fill the white fields of the form in capital letters, mark appropriate fields with X 1. Podaci o podnosiocu zahtjeva / Applicant Details Podnosilac zahtjeva / Applicant Adresa podnosioca zahtjeva Applicant Address Spisak ATC jedinica (ICAO lokacijski indikator) List of ATC Units (ICAO location indicator) Odgovorna lica i kontakt broj Accountable and responsible persons and contact number 1.Odgovorni rukovodilac Accountable Manager 2.Rukovodilac organizacije za osposobljavanje (ukoliko nije pod (1)) Head of the Training Organisation (if different from (1)) 3.Koordinator za komunikaciju Focal Point person Datum početka osposobljavanja ili promjene: Date of intended start of training or change: potpis: potpis: potpis: Operativni detalji dostavljeni uz zahtjev Operational Details to be provided to the Agency with the application Da / Yes Ne / No Obrazloženje podnosioca zahtjeva Training Organisations Exposition Sistem upravljanja sigurnošću Safety management System Programi i planovi osposobljavanja Training Programmes and Plans Sistem upravljanja kvalitetom Quality Management System Dostavljeno / Provided Dostavljen / Provided Dostavljeni / Provided Dostavljen / Provided 3. Usaglašenosti / Compliances Da / Yes Ne / No Interni sistem provjere Internal Audit System Sistem kontrole kvaliteta Quality Management System Sistem kontrole promjena Change Management System ANS-FRM-010 Strana 1 / 5
2 4. Izjava / Declaration U ime, podnosim zahtjev za provjeru ispunjenosti uslova za izdavanje Certifikata o osposobljenosti za sprovođenje stručnog osposobljavanja kontrolora letenja i ovim potvrđujem ispunjenost uslova sa primjenljivim zahtjevima za svo vrijeme trajanja certifikata. On behalf of I hereby apply for verification of compliance with the requirements for issuance of a certificate of qualification for the training of air traffic controllers and with this I confirm compliance with the applicable requirements at all times of certificate life time. Ime lica koje daje izjavu: Name of the person making the declaration: Datum / Date Potpis / Signature Pečat / Stamp 5. Vrsta osposobljavanja/type of Training 5.1 Početno osposobljavanje kontrolora letenja/atco Initial Training Početno osposobljavanje Basic Training Osposobljavanja za dodatna ovlašćenja Rating Training Aerodromska kontrola-vizuelna Aerodrome Control Visual (ADV) Aerodromska kontrola-instrumentalna Aerodrome Control Instrument (ADI) Prilazna kontrola-proceduralna Aerodrome Control Procedural (APP) Prilazna kontrola-nadzorna Approach Control Surveillance (APS) Oblasna kontrola-proceduralna ANS-FRM-010 Strana 2 / 5 Toranjska kontrola Tower Control (TWR) Kontrola kretanja po manevarskim površinama Ground Movement Control (GMC) Kontrola kretanja po manevarskim površinama sa nadzorom Ground Movement Surveillance (GMS) Kontrola u vazdušnom prostoru Air Control (AIR) Aerodromska radarska kontrola Aerodrome Radar Control (RAD) Precizni prilazni radar Precision Approach Radar (PAR) Prilaz po nadzornom radaru Surveillance Radar Approach (SRA) Terminalna kontrola Terminal Control (TCL) Okeanska kontrola
3 5.1.1 Specijalna Special Limitations/Conditions Area Control Procedural (ACP) Oblasna kontrola-nadzorna Area Control Surveillance (ACS) Oceanic Control (OCN) Terminalna kontrola Terminal Control (TCL) Okeanska kontrola Oceanic Control (OCN) 5.2 Osposobljavanje za lokaciju/atco Unit Training Prelazno osposobljavanje / Transitional Training Osposobljavanje prije osposobljavanja na radnom mjestu/pre-on-thejobtraining Osposobljavanje na radnom mjestu / On-the-job Training Specijalna 5.3 Kontinuirano osposobljavanje kontrolora letenja/atco Continuation Training Osposobljavanje osvježenja znanja Refresher Training Doosposobljavanje Conversion Training Specijalna 5.4 Posebna osposobljavanja/development Training Osposobljavanje za instruktora na radnom mjestu/ojti Training Osposobljavanje za procjenjivača/training for Assessors Specijalna ANS-FRM-010 Strana 3 / 5
4 6. Osposobljavanje iz vazduhoplovnog engleskog jezika/aviation English Language Training Osposobljavanje iz opšteg engleskog jezika/general English Language Training Osposobljavanje iz vazduhoplovnog engleskog jezika/aviation English Language Training Osposobljavanje iz vazduhoplovnog engleskog jezika za ACS/APS ovlašćenja Aviation English Language training for ACS/APS ratings 7. Aktivnost/Identification of Activity 7.1 Vrsta aktivnosti/type of Activity Zahtjev za osnovnu provjeru za izdavanje certifikata za stručno osposobljavanje kontrolora letenja Application for ATCOs training organization initial Approval Certificate Zahtjev za izmjene certifikata za stručno osposobljavanje kontrolora letenja Application for ATCOs training organization variation to Approval Certificate Zahtjev za obnovu certifikata za stručno osposobljavanje kontrolora letenja Application for ATCOs training organization renewal Approval Certificate Broj originalnog certifikata (u slučaju i 7.1.3) Number of original Approval Certificate (please complete in case of and 7.1.3) Izdat od strane (u slučaju i 7.1.3) Issued by (please complete in case of and 7.1.3) Specijalna 8. Opis zahtijevanih promjena na već postojećei Certifikat za stručno osposobljavanje kontolora letenja / Description of changes required for under existing ATCOs Training Approval Certificate (opis/description) 8.1 Promjene u samoj organizaciji za stručno osposobljavanje kontrolora letenja Changes to the ATCOs training Organisation ANS-FRM-010 Strana 4 / 5
5 (opis/description) 8.2 Promjene u vršenju osposobljavanja Changes in training performance ANS-FRM-010 Strana 5 / 5
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