Federal Department of the Environment, Transport, Energy and
Communications DETEC
Federal Office of Civil Aviation FOCA
Safety – Division Flight Personnel
3003 Bern
English Language Proficiency Check Level 5/6
Applicant
last name:
Applicant's
Swiss/JAR/EASA
licence number:
first name:
place of birth:
date of birth:
place of origin:
native language(s):
q
q
english
german
private address: postal code:
q
nationality:
q
french
city:
italian
q
other:
street:
phone/fax home:
phone/fax office:
e-mail:
signature of applicant:
invoice to be sent to:
q
q
no examiner invoice
q
q
applicant
company
q
Do not issue licence before next class/type rating acquisition/revalidation/renewal
FTO/RF/ATO (to be filled in for trainees)
name:
Request immediate licence issue
registration number:
name of Head of Training:
JAR/EASA licence number:
location & date:
signature of Head of Training:
Current licence
Aircraft category
q
Aeroplanes
q
SP*
q MP*
*SP = Single pilot operations
VFR/IFR
q
Helicopters
q
SP*
q MP*
*MP = Multi pilot operations
VFR/IFR
q
other: _________________________
q
Trainee
q
PPL
q
VFR only
q
q
CPL
q
VFR only
q
q
ATPL
q
q
Independent Flight Radiotelephone Operator
other: ______________________
Radiotelephony exam in English
passed date: _________________________
Current English Language Proficiency endorsement
expiry date: _________________________
Level: ___________________
Enrolment for:
q
Initial examination for Level 5/6*
q
Repetition of failed Language Proficiency check Level 5/6*
q
Renewal of expired Language Proficiency endorsement Level 5
q
Revalidation of Language Proficiency endorsement Level 5
* Conditions for enrolment: Hold at least Language Proficiency endorsement Level 4
Desired examination date:
Alternative date:
Result of the Language Proficiency Check (to be completed by the Language Assessors)
Remark: If the criteria for (overall) Level 5 are not fulfilled, but no area is below
Level 4, the exam is passed at Level 4 (= minimum requirement according to
ICAO/JAR-FCL).
passed at
failed
Level
(< Level 4)
(4/5/6)
BLANK
Acknowledgement of result
(shall be signed if final result < Level 4)
Applicant's signature:
Part 1: Listening comprehension
Part 2: Speaking ability (for details see page 2)
Result of Language Proficiency Check
(lowest of above intermediate results)
1st Language Assessor:
last name:
Licence number
2nd Language Assessor:
Licence number
first name:
signature:
last name:
first name:
signature:
Location and date:
FOCA Form 69.511 - Version 1.1.2013
1/2
BAZL OFAC UFAC FOCA CH-3003 Bern (Switzerland)
Applicant's Swiss/JAR licence number:
Grade Sheet for English Language Proficiency Check part 2, Speaking ability
(to be completed by the Language Assessors)
passed at
Level
(4/5/6)
failed
(< Level 4)
Pronunciation
Fluency
Vocabulary
Structure
Comprehension
Interaction
Overall result (lowest level of above 6 individual levels)
If any item is failed, the complete Language Proficiency Check is failed and has to be repeated.
Important notes
The repetition of a Language Proficiency Check for Level 5/6 shall be carried out at the same place as the previous
examination. A copy of the previous Language Proficiency Check form must be attached.
The repetition of a failed Language Proficiency Check (result < Level 4) shall be carried out at the same place as the previous
examination, but in an exam session for Level 4 (see AIC B). A copy of the failed Language Proficiency Check form must be
attached.
Hinweis:
Innert 10 Tagen nach Zustellung des Ergebnisses vom Language Proficiency Check kann beim Bundesamt für Zivilluftfahrt, 3003 Bern,
schriftlich die Ausstellung einer beschwerdefähigen Verfügung über das Prüfungsresultat verlangt werden
Remarque:
Il est possible, dans les dix jours suivant la communication du résultat du Language Proficiency Check d'obtenir, sur réquête écrite auprès de
l'Office fédéral de l'aviation civile, 3003 Berne, une décision susceptible de recours portant sur le résultat dudit examen
Avviso:
Entro dieci giorni dall'invio dei resultati del Language Proficiency Check può essere richiesta per iscritto all'Ufficio federale dell'aviazione civile,
3003 Berna, una decisione impugnabile sull'esito dell'esame
Remark:
A candidate may, in the 10 days following the result of the Language Proficiency Check, obtain written confirmation of his/her official result
from the Federal Office of Civil Aviation, 3003 Bern, against which he/she may then appeal. The candidate’s request must be in writing in one
of the official languages (German/French/Italian).
FOCA Form 69.511 - Version 1.1.2013
2/2