FORM I-9
&
FINGERPRINTING
REQUIRED IDENTIFICATION
FORM I-9 & Instructions for completing:
You will need to go online PRIOR to your first day of employment to fill out the form by going
to the following link:
https://secure.i9.talx.com/preauthenticated/LoginCAPTCHA.ascx?Employer=14098
Please bring 2 forms of government issued identification with you to orientation. You also
need to provide 2 clear copies of all identification. Your identification will be used for
several purposes; fingerprinting, completing your Form I-9, and drug testing.
Please refer to the list of acceptable documents attached to this form. In order to complete
your Form I-9, you must bring either 1 document from List A. Or if you prefer, you must
bring 1 document from List B AND 1 supporting document from List C.
Your Identification is used to complete your Form I-9 from the Department of Homeland
Security. Republic Airways Holdings participates in the Federal government’s E-Verification
process.
If you cannot bring the required identification listed below, please contact your
Talent Acquisition Consultant immediately upon receipt of this letter. Failure to
bring the required identification to orientation will jeopardize your continued
training. Identification must be current, unexpired and all names must match.
Fingerprinting:
Please bring 2 original forms of government issued identification such as a Driver’s License,
Passport, Birth Certificate, Social Security Card, State ID, Passport Card, Military ID, or Alien
Registration. (One of the documents must be a photo ID).
PLEASE BRING TWO (2) COPIES OF ANY AND ALL IDENTIFICATION
DOCUMENTS THAT ARE REQUIRED, ALONG WITH THE ORIGINALS.
Updated 2016May24
Drug Testing Information and Donor Checklist
Your employment at Republic Airways is contingent upon passing a pre-employment drug screening for the following
five (5) drugs: Marijuana, Cocaine, Opiates, Phencyclidine (PCP), and Amphetamines (or their metabolites). If
employment is offered and accepted, based on your position and job functions, you will be covered under the Company
Policy and/or the Department of Transportation (DOT) regulations. You may be subject to random testing for drugs,
alcohol, or both. If the circumstances of your position, or a work-related situation deem it necessary, you may also be
subject to Post-Accident, Reasonable Cause/Suspicion, Return-to-Duty, and Follow-up testing. The collection of your
urine will be conducted under a procedure mandated by the DOT. The regulations provide for your privacy unless there is
reason to believe you may have altered or substituted the urine specimen. Please take a few minutes to read the
information below which describes your role in the process.
 You must present a photo ID to the collector. (You may ask the collector to show his/her identification.)
 You will be asked to remove any unnecessary outer garments, (e.g. coat, jacket, hat). All personal belongings
(e.g. purse, briefcase) must remain with outer garments. You may retain your wallet. You may ask for a receipt.
 When instructed by collector, you will wash and dry your hands.
 You will be provided with a sealed specimen bottle or collection container, or the collector may unwrap it in your
presence.
 You may provide the specimen in the privacy of a stall or otherwise partitioned area that allows for individual
privacy.
 You should observe the entire collection procedure. The collector will check the specimen for volume,
temperature and color. The collector will also split the specimen into two (2) specimen bottles and seal each
bottle with a tamper-evident label/seal.
 You should initial the label/seal on each specimen bottle to certify that it is your specimen.
 You should complete the Donor sections on the Custody and Control Form. You will be given a copy of the
completed form after the collector has completed his/her certification.
 You should NOT list medications/prescriptions on a copy of the form other than the one you are given for your
own records.
 In the event of a “shy bladder” and you are unable to provide a specimen of sufficient quantity of urine, you will
be allowed to consume up to 40 ounces of liquid in the three-hour period allowed by the DOT regulations.
The results of the laboratory analysis will be forwarded to your employer’s Medical Review Officer (MRO). If the
laboratory results are negative, the MRO will notify your employer. If the laboratory results are positive, the MRO
will contact you at the phone number you provided to give you the opportunity to discuss the test results and to submit
information demonstrating authorized use of the drug(s) in question. It is at this time that you may request to have the
second part of your specimen analyzed at a DHHS certified laboratory of your choice.
For questions or concerns related to your specific testing experience, please contact the person below affiliated with
your airline certificate:
Republic Airlines – Mary Thorpe, C-DER - office 317/471-2267; cell 317/500-5559
Shuttle America – Tracy Kinkade, C-DER – office 317/471-2274; cell 317/490-7535
Tracy Kinkade, HR Manager of Compliance - office 317/246-2607; cell 317/557-5144
WHY WE FINGERPRINT
On December 6, 2001, the Federal Aviation Administration (FAA) issued an emergency rule
requiring criminal history record checks for all new persons seeking or currently holding
unescorted access or persons authorized to grant unescorted access, to security identification
display areas (SIDA). See Federal Register/Vol. 66, No. 235, December 6, 2001.
For the safety of our guests and associates, Republic Airways Holding’s policy is to require
criminal history records checks for all associates in all positions.
Please fill in Section I of the following “Fingerprint Processing Form” and sign the bottom of the
“Disqualifying Crimes” Form. Please bring these pages with you to your NEW Orientation
Session on your first day of employment.
Thank you,
Corporate Compliance Department
FINGERPRINT PROCESSING FORM
I. EMPLOYEE INFORMATION
______________________________________________________________________________________
Last Name (Legal)
First Name (Legal)
Middle Name (Legal)
Suffix
______________________________________________________________________________________
Aliases (maiden name, previous married name, aka, etc)
______________________________________________________________________________________
Social Security #
Date of Birth (YYYY, MM, DD)
Phone Number
______________________________________________________________________________________
Current Home Address
City
State
Zip Code
______________________________________________________________________________________
Birth place (City, State, Country)
Citizenship
Race/Ethnicity
______________________________________________________________________________________
Gender
Eye Color
Hair Color
Height (ft/inches)
Weight
II. THIS SECTION FOR NON U.S. CITIZENS ONLY:
Are you authorized to work in the United States? ________________ Citizenship#:________________
Alien Registration #: ____________________Non-Immigrant Visa#:____________________________
****Privacy Act Notice****
Authority: The authority for collecting this information is 49 U.S.C. 114, “Transportation Security Administration” and 49 U.S.C.
44936, “Employment Investigations and Restrictions”.
Purpose: This information is needed to verify your identity and retrieve your criminal history record to evaluate your suitability for
access to airport sterile areas and security identification display areas (SIDAs), and aircraft. Your Social Security Number (SSN) will
be used as your identification number in this process and to verify your identity. Furnishing this information, including your SSN, is
voluntary, however, failure to provide it will prevent the completion of your criminal history records check, without which you may
not be granted aircraft, sterile area or SIDA access.
Routine uses: Routine uses of this information include disclosure to the U.S. Office of Personnel Management for processing and
data verification, to the FBI to retrieve your criminal history record, to Transportation Security Administration (TSA) contractors or
other agents who assist in the maintenance and operation of the fingerprint system, to airport operators or aircraft operators to evaluate
suitability for aircraft, sterile area or SIDA access, to appropriate governmental agencies for law enforcement or security purposes, or
in the interests of national security, and to foreign and international governmental authorities in accordance with law and international
agreement.
FOR OFFICE USE ONLY - Two forms ID presented:
{ } Driver’s License { } State ID { } Passport { } Passport Card
{ } Military ID { } Social Security Card { } Birth certificate { } Alien Registration
Revised 03/2016
****Disqualifying Crimes****
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Forgery of certificates, false marking of aircraft, and other aircraft registration violation; 49 U.S.C.
46306.
Interference with air navigation; 49 U.S.C. 46308.
Improper transportation of a hazardous material; 449 U.S.C. 46312.
Aircraft piracy; 49 U.S.C. 46502.
Interference with flight crewmembers or flight attendants; 49 U.S.C. 46504.
Commission of certain crimes aboard aircraft in flight; 49 U.S.C. 46t506.
Carrying a weapon or explosive aboard aircraft; 40 U.S.C. 46505.
Conveying false information and threats; 49U.S.C. 46507.
Aircraft piracy outside the special aircraft jurisdiction of the United States; 49 U.S.C. 46502(b).
Lighting violations involving transporting controlled substances; 49 U.S.C. 46315.
Unlawful entry into an aircraft or airport area that serves air carriers or foreign air carriers contrary to
established requirements; 49 U.S.C. 46314.
Destruction of an aircraft or aircraft facility; 49 U.S.C. 32.
Murder
Assault with intent to murder.
Espionage.
Sedition.
Kidnapping or hostage taking.
Treason.
Rape or aggravated sexual assault.
Unlawful possession, use, sale, distribution or manufacturing of an explosive or weapon.
Extortion.
Armed or felony unarmed robbery.
Distribution of, or intent to distribute, a controlled substance.
Felony arson.
Felony involving a threat.
Felony involving – (I) Willful destruction of property;
(ii) Importation of manufacture of a controlled substance;
(iii) Burglary;
(iv) Theft
(v) Dishonesty, fraud or misrepresentation;
(vi) Possession or distribution of stolen property;
(vii) Aggravated assault;
(viii) Bribery;
(ix) Illegal possession of a controlled substance punishable of a maximum term of imprisonment of
more than one year, or any other crime classified as a felony that the FAA determines indicates a
propensity for placing contraband aboard an aircraft in return for money.
Violence at International airports; 18 U.S.C. 37.
Conspiracy or attempt to commit any acts listed above
The information I have provided on this application is true, complete, and correct to the best of my knowledge
and belief and is provided in good faith. I understand that a knowing and willful false statement on this
application can be punished by fine or imprisonment or both. (See section 1001 of Title 18 United States Code.)
I acknowledge that I am obligated to disclose to the aircraft operator within 24 hours if I am convicted of any
disqualifying criminal offense that occurs while I have unescorted access authority.
I have not been convicted, pled guilty, pled no contest or found not guilty of by reason of insanity, of any of the
disqualifying crimes listed above, in any jurisdiction in the last 10 years. I understand that my fingerprints and
demographic information may be re-submitted periodically according to FAA/TSA regulations.
__
Applicant’s Signature
Revised 03/2016
Printed Name
____________________
Date
CANADA
RAH operates flights into international destinations
including Canada. Security and enforcement at the
Canada/US border have been significantly heightened.
Therefore, Canada requires additional documentation
on any conviction (felony and/or misdemeanor) that
may show up on an employee’s criminal history record check. The ruling applies
to any associates traveling to/from Canada for business related purposes. This
applies to Pilots, Flight Attendants and Mechanics that may have to go to Canada
for work assignments.
There have been previous cases of associates not completing this form that are
arrested at the border. In most cases, these associates are subsequently separated
from their employment due to their inability to travel to/from Canada.
If you have a documented criminal conviction on your record, you must fill out the
Application for Criminal Rehabilitation form in order to travel to/from Canada.
The fee for rehabilitation starts at $200 and can go up to $1000 based on the level
of offense.
Please go to www.cic.gc.ca for forms and more information.
State of Pennsylvania
Employee’s Acknowledgement of Physician Panel
We are required by law to have a signed copy of the State of Pennsylvania’s Employee’s
Acknowledgment of Physician Panel Form on file at the time of hire if you are going to be
working in Pennsylvania.
ALL CREW:
There is no way for us to know if you will be based in PA or not until after you have bid for your
base assignment during your training in the next few weeks. Again, we are required by law to
have a signed copy of the State of Pennsylvania’s Employee Acknowledgment of Physician Panel
form on file at the time of hire even though we don’t know where you will be based yet.
Therefore, if you are a pilot or flight attendant, you must fill out the following Employee
Acknowledgment of Physician Panel Form and bring it with you to class on the first day of
employment with Republic Airways Holdings for us to hold in your file until such time as we
know your final base assignment. You will return this form to the Human Resources
Orientation Coordinator during your New Hire Orientation on your first day of training.
ALL OTHER EMPLOYEES:
Again, we are required by law to have a signed copy of the State of Pennsylvania’s Employee
Acknowledgment of Physician Panel Form on file at the time of hire if you are going to be
working in Pennsylvania. Therefore, if you are an employee that will be based in Pennsylvania,
you must fill out the following Employee Acknowledgment of Physician Panel Form and bring it
with you to class on the first day of employment with Republic Airways Holdings. You will
return this form to the Human Resources Orientation Coordinator during your New Hire
Orientation.
If you are NON-crew employee and you are not going to be working in Pennsylvania, you do not
need to have this form filled out.
Thank you.
Human Resources Worker’s Compensation Team
Please direct any questions to [email protected]