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					FILES!
Processing Pilot &
Flight Instructor
Certification Files
OBJECTIVE:


PILOT EXAMINERS WILL BE
ABLE TO DEMONSTRATE THEIR
ABILITY TO ACCURATELY
PROCESS THE AIRMAN
APPLICATION (4-00)
A File return rate greater than
        10 percent is



UNACCEPTABLE!!!
  TYPE OR PRINT ALL ENTRIES IN INK                                                                                       Form Approved OMB No: 2120-0021

               DEPARTMENT OF TRANSPORTATION
               FEDERAL AVIATION ADMINISTRATION
                                                           Airman Certificate and/or Rating Application

     I Application Information                   Student            Recreational               Private        Commercial                Airline Transport           Instrument
       Additional Rating       Airplane Single-Engine Airplane Multiengine                               Rotorcraft Balloon Airship                 Glider     Powered-Lift
          Flight Instructor ____ Initial _____ Renewal ____ Reinstatement                                 Additional Instructor Rating               Ground Instructor
          Medical Flight Test              Reexamination                Reissuance of ____________Certificate                           Other ___________________
   A. Name (Last, First, Middle)                                                        B . SSN ((US Only)           C. Date of Birth            D. Place of Birth
                                                                                                                            Month Day Year

  E. Address                                                                           F. Citizenship                     Specify G.Do you read, speak, write, & understand
                                                                                                                                    the English language?      Yes
                                                                                              USA             Other________                                                   No
  City, State, Zip Code                                                                 H. Height          I. Weight          J. Hair          K. Eyes             L. Sex
                                                                                                                                                                            Male
                                                                                                                                                                            Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                     N. Grade Pilot Certificate            O. Certificate Number       P. Date Issued
                                                     Yes             No
Q. Do you hold a                  Yes     R. Class of Certificate                       S. Date Issued                        T. Name of Examiner
    Medical Certificate?
                                  No
U.Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or                  V. Date of Final Conviction
  stimulant drugs or substances?



                                                                                                                                                                                     FAA FORM 8710-1
                                                                                                    Yes             No

  II. Certificate or Rating Applied For on Basis of:

  A. Completion of         1. Aircraft to be used (if flight test required)                               2a. Total time in this aircraft/SIM/FTD        2b. Pilot in command
     Required Test
                                                                                                                                               hours                        hours

   B. Military             1. Service                                               2. Date Rated                                       3. Rank or Grade and Service Number




                                                                                                                                                                                           4-00
      Competence
      Obtained in
                           4a. Flown 10 hours as pilot in command in                                                 4b. US Military PIC & Instrument check in last 12 months
                               last 12 months in the following Military Aircraft.                                        (List Aircraft.

                           1. Name and Location of Training Agency or Training Center                                                                    1a. Certificate Number

       C. Graduate of
          Approved
          Course           2. Curriculum From Which Graduated                                                                                            3. Date



  D. Holder of       1. Country                                                     2. Grade of License                                    3. Number
     Foreign License
     Issued By
                           4. Ratings


  E. Completion of Air     1. Name of Air Carrier                                   2. Date                            3. Which Curriculum
  Carrier’s Approved
  Training Program
                                                                                                                          Initial            Upgrade            Transition
 III Record of Pilot time ( Do not write in the shaded areas. )
                                                                                      Instrument Night Night      Night      Night                                        Number
                                        S Pilot   Cross       Cross           Cross                                                   Number Number of       Number of Number of
                                                                              Country            Instr. Take-off/ PIC        Takeoff/ of                                  of
                                                                                                                                                                       Powered
                                        o   in    Country     Country                                                                        Aero-tows       Ground
               Total     Instruction                                                             Rec’d Landing               Landing Flights                              Free
                                         l Comand Instruction Solo            PIC                                                                            Launches Launches
                         Received                                                                                            PIC                                          Flights
                                        o (PIC) Received
                                           PIC                                PIC                                 PIC       PIC
  Airplanes                                                                   SIC                                           SIC
                                           SIC                                                                    SIC
                                           PIC                                PIC                                 PIC       PIC
Rotorcraft                                 SIC                                SIC                                           SIC
                                                                                                                  SIC
                                           PIC                                PIC                                 PIC       PIC
Powered Lift                               SIC                                SIC                                 SIC       SIC
Gliders
Lighter
Than Air
Simulator
 Training
  Device
 PCATD
IV. Have you failed a test for this certificate or rating ?                              Yes             No
 V. Applicant‟s Certification -- -- I certify that all statements and answers provided by me on this application form are complete and true to the best of my knowledge
agree that they are to be considered as part of the basis for issuance of any FAA certificate to me. I have read and understand the Privacy Act statement that accompanies this form.
 and I agree that they are to be considered as part of the basis for issuance of any FAA certificate to me. I have also read and understand the Privacy Act statement
 that accompanies this form.
Signature of Applicant                                                                                     Date



  FAA Form 8710-1 (4-00) Supersedes Previous Edition                                                                                                NSN: 0052-00-682-5007
COMMERCIAL SOFTWARE
              APPLICATION INFORMATION

TYPE OR PRINT ALL ENTRIES IN INK                                                                         Form Approved OMB No: 2120-0021


          DEPARTMENT OF TRANSPORTATION
          FEDERAL AVIATION ADMINISTRATION
                                               Airman Certificate and/or Rating Application

I Application Information                   Student         Recreational     Private           Commercial             Airline Transport           Instrument
   Additional Rating                        Airplane Single-Engine    Airplane Multiengine      Rotorcraft    Balloon      Airship      Glider    Powered Lift
   Flight Instructor ____ Initial _____ Renewal ____ Reinstatement                     Additional Instructor Rating                  Ground Instructor
    Medical Flight Test                 Reexamination            Reissuance of _______________Certificate               Other _______________________




      Aircraft                                                                                                           Lighter Than Air
                          PERSONAL INFORMATION AND
                                           IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                              B . SSN (US Only)                  C. Date of Birth                     D. Place of Birth
                                                                                                                                        Month Day Year


  E. Address                                                                                 F. Citizenship                        Specify             G. Do you read, speak, write, & understand
                                                                                                                                                          the English Language?
                                                                                                   USA                Other____________                                                     Yes      No
  City, State, Zip Code                                                                      H. Height              I. Weight                J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                  Male
                                                                                                                                                                                                  Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                      O. Certificate Number            P. Date Issued

                                                         Yes               No
Q. Do you hold a                            R. Class of Certificate                           S. Date Issued                                 T. Name of Examiner
                                   Yes
   Medical Certificate?
                                   No

U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?          V. Date of Final Conviction

                                                                                                                          Yes                  No




                          W
                          PERSONAL INFORMATION AND
                                           IDENTIFICATION DATA
                                                                                             B . SSN (US Only)                  C. Date of Birth                   D. Place of Birth
  A. Name
 A. Name(Last, First, Middle)Middle)
          (Last, First,                                                                                                               Month Day Year


  E. Address                                                                                 F. Citizenship                      Specify             G. Do you read, speak, write & understand
                                                                                                                                                        the English Language?
                                                                                                   USA                Other____________                                                    Yes       No
  City, State, Zip Code                                                                      H. Height              I. Weight              J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                 Male
                                                                                                                                                                                                 Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                    O. Certificate Number            P. Date Issued

                                                         Yes               No
Q. Do you hold a                            R. Class of Certificate                          S. Date Issued                                T. Name of Examiner
                                   Yes
   Medical Certificate?
                                   No


             A. Name (Last, First, Middle)                                                                                                                          V.
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances? Date of Final Conviction
                                                                                                                          Yes                No



                •Legal name -- Maximum 3 names
                                                                                                              Signature                                                            X. Date
                                 Medical Statement: I have no known physical defect which makes
                                 me unable to pilot a glider or free balloon




                •No Middle Name -- “NMN”
                • Middle Initial Only -- “ Initial Only”
                • Jr. , II, etc. -- Indicate
                          PERSONAL INFORMATION AND
                                            IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                              B. SSN (US Only)                   C. Date of Birth                     D. Place of Birth
                                                                                                                                        Month Day Year


  E. Address                                                                                 F. Citizenship                        Specify             G. Do you read, speak, write & understand
                                                                                                                                                          the English Language?
                                                                                                   USA                Other____________                                                        Yes       No
  City, State, Zip Code                                                                      H. Height              I. Weight                J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                     Male
                                                                                                               .                    .                                                                Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                      O. Certificate Number            P. Date Issued
                     B. SSN (US Only)                    Yes               No
                                                                                             S. Date Issued                                  T. Name of Examiner
                    MUST CONTAIN ONE OF THE FOLLOWING:
Q. Do you hold a                    Yes     R. Class of Certificate
   Medical Certificate?
                                    No


                      •“NONE” -- IF NEVER ISSUED.                                                                                                                   V.
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances? Date of Final Conviction
                                                                                                                          Yes                  No


                      •“DO NOT USE”
                                                                                                              Signature                                                              X. Date
                                  Medical Statement: I have no known physical defect which makes
                                  me unable to pilot a glider or free balloon



                      • U. S. SOCIAL SECURITY NUMBER
                      • IT IS NOT TO APPEAR ON AN “ORIGINAL
                        ISSUANCE” AIRMAN CERTIFICATE.
                          PERSONAL INFORMATION AND
                                           IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                              B . SSN (US Only)                  C. Date of Birth                  D. Place of Birth
                                                                                                                                        Month Day Year

  E. Address                                                                                 F. Citizenship                     Specify             G. Do you read, speak, write, & understand
                                                                                                                                                       the English Language?
                                                                                                   USA                Other____________                                                    Yes       No
  City, State, Zip Code                                                                      H. Height              I. Weight             J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                 Male
                                                                                                               .                    .                                                            Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                   O. Certificate Number            P. Date Issued

                                                         Yes               No
Q. Do you hold a
   Medical Certificate?
                                   Yes      R. Class of Certificate
                                                                      C. DATE OF BIRTH       S. Date Issued                               T. Name of Examiner




                                                                         • EIGHT DIGITS
                                   No

                                                                                                                                                                    V.
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances? Date of Final Conviction
                                                                                                                          Yes               No


                                                                         • MONTH FIRST                        Signature                                                           X. Date




                                                                         • AGREES WITH OTHER
                                                                           DOCUMENTS
                          PERSONAL INFORMATION AND
                                           IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                              B . SSN (US Only)                  C. Date of Birth
                                                                                                                                                                   D. Place of Birth
                                                                                                                                        Month Day Year


  E. Address                                                                                 F. Citizenship                      Specify             G. Do you read, speak, write & understand
                                                                                                                                                        the English Language?
                                                                                                   USA                Other____________                                                      Yes       No
  City, State, Zip Code                                                                      H. Height              I. Weight              J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                   Male
                                                                                                                                                                                                   Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                    O. Certificate Number           P. Date Issued

                                                         Yes               No
Q. Do you hold a
   Medical Certificate?
                                   Yes      R. Class of Certificate
                                                                          D. Place of Birth  S. Date Issued                                T. Name of Examiner

                                   No


                                                                                    • CITY & STATE                                                                  V.
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances? Date of Final Conviction
                                                                                                                          Yes                No



                                                                                    • COUNTY & STATE
                                                                                                              Signature                                                            X. Date




                                                                                      IF CITY IS UNKNOWN
                                                                                    • CITY & COUNTRY
                                                                                      IF OUTSIDE THE USA
                          PERSONAL INFORMATION AND
                                           IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                              B . SSN (US Only)                  C. Date of Birth                  D. Place of Birth
                                                                                                                                       Month Day Year


  E. Address (Please See Instructions Before Completing)                                     F. Citizenship           Specify                       G. Do you read, speak, write & understand
                                                                                                                                                       the English Language?
                                                                                                   USA                Other____________                                                   Yes       No
  City, State, Zip Code                                                                      H. Height              I. Weight             J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                Male
                                                                                                               .                    .                                                           Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                   O. Certificate Number            P. Date Issued



Q. Do you hold a
                               E. Address                  Yes

                                            R. Class of Certificate
                                                                           No
                                                                                             S. Date Issued                               T. Name of Examiner


                                  • PERMANENT MAILING ADDRESS
                                    Yes
   Medical Certificate?
                                    No

                                                                                                                                                                    V.
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances? Date of Final Conviction


                                  • P. O. BOX or RURAL ROUTE
                                  Medical Statement: I have no known physical defect which makes
                                                                                                              Signature
                                                                                                                          Yes               No
                                                                                                                                                                                  X. Date



                                      • INCLUDE EXPLANATION FOR
                                  me unable to pilot a glider or free balloon




                                        NO STREET ADDRESS AND
                                        A MAP TO, OR DESCRIPTION
                                        OF, RESIDENCE LOCATION.
                          PERSONAL INFORMATION AND
                                           IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                               B . SSN (US Only)                  C. Date of Birth                  D. Place of Birth
                                                                                                                                         Month Day Year


  E. Address                                                                                   F. Citizenship                        Specify         G. Do you read, speak, write & understand
                                                                                                                                                        the English Language?
                                                                                                      USA              Other____________                                                    Yes       No
  City, State, Zip Code                                                                       H. Height              I. Weight             J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                  Male
                                                                                                                                                                                                  Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                           N. Grade Pilot Certificate                   O. Certificate Number            P. Date Issued

                                                         Yes               No
Q. Do you hold a                            R. Class of Certificate                           S. Date Issued                               T. Name of Examiner
                                   Yes
   Medical Certificate?
                                   No

U. Have you ever been convicted for violation of any Federal or State statutes pertaining to narcotic drugs, marijuana, or depressant                                 V. Date of Final Conviction
                                                          F. Citizenship                                                   Yes                 No

                                                                                                                Signature                                                          X. Date


                                                               • USA CHECKED
                                                                    OR
                                                               •CHECK OTHER & SHOW
                                                               •COUNTRY OF CITIZENSHIP
                          PERSONAL INFORMATION AND
                                           IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                              B . SSN (US Only)                  C. Date of Birth                     D. Place of Birth
                                                                                                                                        Month Day Year


  E. Address                                                                                 F. Citizenship                        Specify             G. Do you read, speak, write & understand
                                                                                                                                                          the English Language?
                                                                                                   USA                Other____________                                                    Yes         No
  City, State, Zip Code                                                                      H. Height              I. Weight                J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                   Male
                                                                                                                                                                                                   Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                      O. Certificate Number            P. Date Issued

                                                         Yes               No
Q. Do you hold a
   Medical Certificate?           G. Do you read, speak, write, & understand
                                    Yes     R. Class of Certificate                          S. Date Issued                                  T. Name of Examiner

                                    No

                                     the English Language?                                                                                                          V.
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances? Date of Final Conviction
                                                                                                                          Yes                  No


                                          • MAKE SURE EITHER “YES” OR
                                  Medical Statement: I have no known physical defect which makes
                                  me unable to pilot a glider or free balloon
                                                                                                              Signature                                                              X. Date




                                             “NO” HAS BEEN MARKED
                                          • THE APPLICANT‟S OPINION
                          PERSONAL INFORMATION AND
                                            IDENTIFICATION DATA

  A. Name (Last, First, Middle)                                                              B . SSN (US Only)                  C. Date of Birth                    D. Place of Birth
                                                                                                                                        Month Day Year


  E. Address                                                                                 F. Citizenship                       Specify             G. Do you read, speak, write & understand
                                                                                                                                                         the English Language?
                                                                                                   USA                Other____________                                                    Yes        No
  City, State, Zip Code                                                                      H. Height              I. Weight               J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                  Male
                                                                                                                                    .                                                             Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                     O. Certificate Number            P. Date Issued

                                                         Yes               No
Q. Do you hold a                            R. Class of Certificate                           S. Date Issued                                T. Name of Examiner
                                   Yes
   Medical Certificate?
                                   No


                                                               H. Height
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?
                                                                                                                          Yes                 No
                                                                                                                                                                                V. Date of Final Conviction



                                                                                                               Signature


                                                                      • WHOLE INCHES
                                                                      • CONVERT FROM
                                                                        METERS, ETC.
                          PERSONAL INFORMATION AND
                                           IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                              B . SSN (US Only)                  C. Date of Birth                     D. Place of Birth
                                                                                                                                        Month Day Year


  E. Address                                                                                 F. Citizenship                        Specify             G. Do you read, speak, write & understand
                                                                                                                                                          the English Language?
                                                                                                   USA                Other____________                                                      Yes       No
  City, State, Zip Code                                                                      H. Height              I. Weight                J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                   Male
                                                                                                                                                                                                   Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                      O. Certificate Number            P. Date Issued

                                                         Yes               No
Q. Do you hold a                            R. Class of Certificate                           S. Date Issued                                 T. Name of Examiner
                                   Yes
   Medical Certificate?
                                   No

U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?           V. Date of Final Conviction
                                                                                                                          Yes                  No

                                                                        I. Weight                              Signature




                                                                                    • WHOLE POUNDS
                                                                                    • CONVERT WHEN
                                                                                      NECESSARY
                          PERSONAL INFORMATION AND
                                           IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                              B . SSN (US Only)                  C. Date of Birth                    D. Place of Birth
                                                                                                                                        Month Day Year

  E. Address                                                                                 F. Citizenship                       Specify             G. Do you read, speak, write & understand
                                                                                                                                                         the English Language?
                                                                                                   USA                Other____________                                                     Yes       No
  City, State, Zip Code                                                                      H. Height              I. Weight               J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                  Male
                                                                                                                                                                                                  Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                     O. Certificate Number            P. Date Issued

                                                         Yes               No
Q. Do you hold a                            R. Class of Certificate                          S. Date Issued                                 T. Name of Examiner
                                   Yes
   Medical Certificate?
                                   No                                                            J. Hair
                                                                                                                                                                    V.
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances? Date of Final Conviction


                                                                                                         • SPELLED OUT
                                                                                                                          Yes                 No

                                                                                                              Signature                                                             X. Date




                                                                                                         • BLACK, RED,
                                                                                                           BROWN, BLOND,
                                                                                                           GRAY, or BALD
                          PERSONAL INFORMATION AND
                                           IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                              B . SSN (US Only)                   C. Date of Birth                     D. Place of Birth
                                                                                                                                        Month Day Year

  E. Address                                                                                 F. (Citizenship)                       Specify           G. Do you read, speak, write & understand
                                                                                                                                                         the English Language?
                                                                                                   USA                 Other____________                                                     Yes       No
  City, State, Zip Code                                                                      H. Height               I. Weight             J. Hair              K. Eyes                   L. Sex
                                                                                                                                                                                                   Male
                                                                                                                                                                                                   Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                       O. Certificate Number            P. Date Issued

                                                         Yes               No
Q. Do you hold a                            R. Class of Certificate                          S. Date Issued                                T. Name of Examiner
                                   Yes
   Medical Certificate?
                                   No
                                                                                              K. Eyes
                                                                                                   • SPELLED OUT
                                                                                                                                                                    V.
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances? Date of Final Conviction
                                                                                                                          Yes                   No

                                                                                                                Signature                                                             X. Date



                                                                                                   • BLUE, BROWN,
                                                                                                     BLACK, HAZEL,
                                                                                                     GREEN, or GRAY
                          PERSONAL INFORMATION AND
                                           IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                              B . SSN (US Only)                  C. Date of Birth                     D. Place of Birth
                                                                                                                                       Month Day Year


  E. Address                                                                                 F. Citizenship                        Specify             G. Do you read, speak, write & understand
                                                                                                                                                          the English Language?
                                                                                                   USA                Other____________                                                     Yes        No
  City, State, Zip Code                                                                      H. Height              I. Weight                J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                   Male
                                                                                                                                                                                                   Female
M. Do you now hold , or have you ever held an FAA Pilot Certificate?                         N. Grade Pilot Certificate                      O. Certificate Number            P. Date Issued

                                                         Yes               No
Q. Do you hold a                            R. Class of Certificate                          S. Date Issued                                  T. Name of Examiner
                                   Yes
   Medical Certificate?
                                   No

                                                                                                                                                                    V.
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances? Date of Final Conviction

                                                                                                                L. Sex
                                                                                                              Signature
                                                                                                                          Yes                  No
                                                                                                                                                                                     X. Date


                                                                                                                • MAKE SURE AN
                                                                                                                  ANSWER IS
                                                                                                                  MARKED
                          PERSONAL INFORMATION AND
                                            IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                              B . SSN (US Only)                  C. Date of Birth                     D. Place of Birth
                                                                                                                                        Month Day Year

  E. Address                                                                                 F. Citizenship                        Specify           G. Do you read, speak, write & understand
                                                                                                                                                        the English Language?
                                                                                                   USA                Other____________                                                       Yes       No
 City, State, Zip Code                                                                       H. Height              I. Weight             J. Hair              K. Eyes                   L. Sex
                                                                                                                                                                                                    Male
                                                                                                                                                                                                    Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                      O. Certificate Number            P. Date Issued

                                                             Yes                No

Q. Do you hold a                             R. Class of Certificate                          S. Date Issued                              T. Name of Examiner
                                    Yes
   Medical Certificate?
                                    No

U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?           V. Date of Final Conviction
                                                                                                                          Yes                  No
                                                    have you ever held an FAA Pilot Certificate?
               M. Do you now hold, orknown physical defect which makes
                       Medical Statement: I have no
                                                                        Signature
                                  me unable to pilot a glider or free balloon


                   • ANSWER IS “NO” IF
                     APPLICATION IS ON BASIS
                     OF FOREIGN LICENSE OR
                     MILITARY COMPETENCE.
                          PERSONAL INFORMATION AND
                                           IDENTIFICATION DATA
 A. Name (Last, First, Middle)                                                               B . SSN (US Only)                  C. Date of Birth                     D. Place of Birth
                                                                                                                                       Month Day Year


 E. Address                                                                                 F. Citizenship                         Specify             G. Do you read, speak, write & understand
                                                                                                                                                         the English Language?
                                                                                                   USA                Other____________                                                      Yes          No
 City, State, Zip Code                                                                       H. Height              I. Weight                J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                   Male
                                                                                                                                                                                                   Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                      O. Certificate Number            P. Date Issued

                                                        Yes               No
Q. Do you hold a                   Yes     R. Class of Certificate                           S. Date Issued                                  T. Name of Examiner
   Medical Certificate?
                                   No

                                                                                                                                                                   V.
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances? Date of Final Conviction
                                                   N. Grade Pilot Certificate                                             Yes                  No

                                                                                                              Signature                                                              X. Date


                                                           STUDENT, RECREATIONAL,
                                                           PRIVATE, COMMERCIAL, OR ATP
                                                          NOT FLIGHT INSTRUCTOR
                          PERSONAL INFORMATION AND
                                           IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                              B . SSN (US Only)                  C. Date of Birth                     D. Place of Birth
                                                                                                                                       Month Day Year


  E. Address                                                                                 F. Citizenship                        Specify             G. Do you read, speak, write & understand
                                                                                                                                                          the English Language?
                                                                                                   USA                Other____________                                                        Yes       No
  City, State, Zip Code                                                                      H. Height              I. Weight                J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                     Male
                                                                                                                                                                                                     Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                      O. Certificate Number            P. Date Issued

                                                         Yes               No
Q. Do you hold a                            R. Class of Certificate                          S. Date Issued                                  T. Name of Examiner
                                   Yes
   Medical Certificate?
                                   No

                                                                                                                                                                    V.
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances? Date of Final Conviction
                                                                                        O. Certificate Number             Yes                  No



                                                                                           • COMPARE WITH
                                                                                                              Signature                                                              X. Date




                                                                                             THE APPLICANT‟S
                                                                                             CERTIFICATE.
                          PERSONAL INFORMATION AND
                                           IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                              B . SSN (US Only)                  C. Date of Birth                     D. Place of Birth
                                                                                                                                        Month Day Year


  E. Address                                                                                 F. Citizenship)                       Specify             G. Do you read, speak, write & understand
                                                                                                                                                          the English Language?
                                                                                                   USA                Other____________                                                      Yes       No
 City, State, Zip Code                                                                       H. Height              I. Weight                J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                   Male
                                                                                                                                                                                                   Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                      O. Certificate Number            P. Date Issued
                                                         Yes               No
Q. Do you hold a                            R. Class of Certificate                          S. Date Issued                                  T. Name of Examiner
                                   Yes
   Medical Certificate?
                                   No

                                                                                                                                                                    V.
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances? Date of Final Conviction
                                                                                      P. Date Issued                      Yes                  No

                                                                                                               Signature


                                                                                         • AS SHOWN ON
                                                                                           THE CERTIFICATE.
                           PERSONAL INFORMATION AND
                                           IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                              B . SSN (US Only)                  C. Date of Birth                     D. Place of Birth
                                                                                                                                       Month Day Year


  E. Address                                                                                 F. Citizenship)                       Specify             G. Do you read, speak, write & understand
                                                                                                                                                          the English Language?
                                                                                                   USA                Other____________                                                     Yes        No
  City, State, Zip Code                                                                      H. Height              I. Weight                J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                   Male
                                                                                                                .                   .                                                              Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                      O. Certificate Number            P. Date Issued

                                                         Yes               No
 Q. Do you hold a                 Yes       R. Class of Certificate                           S. Date Issued                                 T. Name of Examiner
    Medical Certificate?
                                  No

U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?           V. Date of Final Conviction
                                                                                                                          Yes                  No

                                                                                                               Signature
                Q. Do you hold a Medical Certificate?
                                  Medical Statement: I have no known physical defect which makes
                                  me unable to pilot a glider or free balloon



                      • ASSURE THAT AN ANSWER
                        IS MARKED.
                          PERSONAL INFORMATION AND
                                           IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                              B . SSN (US Only)                  C. Date of Birth                    D. Place of Birth
                                                                                                                                       Month Day Year

  E. Address                                                                                 F. Citizenship                       Specify             G. Do you read, speak, write & understand
                                                                                                                                                         the English Language?
                                                                                                   USA                Other____________                                                    Yes        No
  City, State, Zip Code                                                                      H. Height              I. Weight               J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                  Male
                                                                                                                                                                                                  Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                     O. Certificate Number            P. Date Issued

                                                         Yes               No
Q. Do you hold a                                                                              S. Date Issued                                T. Name of Examiner
                                    Yes     R. Class of Certificate
   Medical Certificate?
                                    No

U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?           V. Date of Final Conviction
                                                                                                                          Yes                 No

                                                                                                               Signature
                           R. Class of Certificate
                                  Medical Statement: I have no known physical defect which makes
                                  me unable to pilot a glider or free balloon




                              • ENTRY MUST BE CLASS
                                SHOWN ON CERTIFICATE
                                (FIRST/1st, SECOND/ 2nd, or
                                THIRD/3rd)
   Minimum Medical
    Certificate Class

1. Glider or Balloon - None
2. Recreational Pilot - Third
3. Private Pilot - Third
4. Commercial Pilot - Third
                          (cont)
     Minimum Medical
      Certificate Class

5.Airline Transport Pilot - Third
6. Instrument Rating - Third
7. Additional Category/Class - Third
8. Flight Instructor - None?
                          PERSONAL INFORMATION AND
                                          IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                              B . SSN (US Only)                  C. Date of Birth                    D. Place of Birth
                                                                                                                                       Month Day Year


 E. Address                                                                                  F. Citizenship                       Specify             G. Do you read, speak, write & understand
                                                                                                                                                         the English Language?
                                                                                                   USA                Other____________                                                    Yes       No
 City, State, Zip Code                                                                       H. Height              I. Weight               J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                  Male
                                                                                                                                                                                                  Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                     O. Certificate Number            P. Date Issued

                                                         Yes               No
Q. Do you hold a                   Yes      R. Class of Certificate                          S. Date Issued                                 T. Name of Examiner
   Medical Certificate?
                                   No

U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?         V. Date of Final Conviction
                                                                                                                          Yes                 No




                                                                         S. Date Issued                                          T. Name of Examiner
                                                                                 • MAKE SURE ENTRIES
                                                                                   MATCH CERTIFICATE
                          PERSONAL INFORMATION AND
                                          IDENTIFICATION DATA
  A. Name (Last, First, Middle)                                                              B . SSN (US Only)                  C. Date of Birth                     D. Place of Birth
                                                                                                                                       Month Day Year

  E. Address (Please See Instructions Before Completing)                                     F. Citizenship                        Specify             G. Do you read, speak, write & understand
                                                                                                                                                          the English Language?
                                                                                                   USA                Other____________                                                        Yes       No
  City, State, Zip Code                                                                      H. Height              I. Weight                J. Hair             K. Eyes                 L. Sex
                                                                                                                                                                                                     Male
                                                                                                                                                                                                     Female
M. Do you now hold, or have you ever held an FAA Pilot Certificate?                          N. Grade Pilot Certificate                      O. Certificate Number            P. Date Issued

                                                           Yes             No
Q. Do you hold a                            R. Class of Certificate                           S. Date Issued                                 T. Name of Examiner
                                   Yes
   Medical Certificate?
                                   No
U. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances?             V. Date of Final Conviction
                                                                                                                                Yes                    No




                    U. Have you ever been convicted ... ?                                                                               V. Date ...
                          • NOT ALCOHOL RELATED
                          • ASSURE THAT EITHER YES OR NO
                             HAS BEEN MARKED.
                          • DATE OF FINAL CONVICTION.
                      CERTIFICATE OR RATING
                      APPLIED FOR ON BASIS OF:
II. Certificate or Rating Applied For on Basis of:
                            1. Aircraft to be used (if flight test required )              2a. Total time in this aircraft / SIM / FTD               2b. Pilot in command
   A. Completion of
      Required Test
                                                                                                                                         hours                                                  hours
                            1. Service                                                     2. Date Rated                                             3. Rank or Grade and Service Number
   B. Military
     Competence
     Obtained in            4a. Flown10 hours PIC in last 12 months in the following Military Aircraft.             4b. US Military PIC & Instrument check in last 12 months(List Aircraft)



                            1. Name and Location of Training Agency of Training Center                                                                                      1a. Certificate Number
   C. Graduate of
      Approved
      Course
                            2. Curriculum From Which Graduated                                                                                                              3. Date



                            1. Country                                                     2. Grade of License                                            3. Number
   D. Holder of Foreign
      License
      Issued By
                            4. Ratings



   E. Completion of Air     1. Name of Air Carrier                                           2. Date                                3. Which Curriculum
      Carrier‟s Approved
      Training Program
                                                                                                                                         Initial            Upgrade                   Transition
                     III RECORD OF PILOT TIME

 III Record of Pilot time (Do not write in the shaded areas.)
                                             Pilot                                                                Night        Night                                                            Number of   Number of
                     Instruction               in    Cross Country Cross Country                                                                            Night      Number of    Number of
            Total                  Solo                                            Cross Country   Instrument   Instruction   Take-off/                                                          Ground      Powered
                      Received             Command     Instruction     Solo                                                                Night PIC       Takeoff/      Flights    Aero-Tows
                                                                                        PIC                      Received     Landing                                                           Launches    Launches
                                             (PIC)      Received                                                                                         Landing PIC
                                          PIC                                      PIC                                                    PIC          PIC

Airplane                                  SIC                                      SIC                                                    SIC          SIC

                                          PIC                                      PIC                                                    PIC          PIC
 Rotor-
 craft                                    SIC                                      SIC                                                    SIC          SIC

                                          PIC                                      PIC                                                    PIC          PIC
Powered
  Lift                                    SIC                                      SIC                                                    SIC          SIC



 Gliders


Lighter
than Air

Simulator

Training
 Device

 PCATD


IV. Have you failed a test for this certificate or rating ?                              Yes                     No
V. Applicant‟s Certification -- I certify that all statements and answers provided by me on this application form are complete and true to the best of my knowledge
and I agree that they are to be considered as part of the basis for issuance of any FAA certificate to me. I have also read and understand the Privacy Act statement
that accompanies this form.
Signature of Applicant                                                                                                                            Date



FAA Form 8710-1 (4-00) Supersedes Previous Edition                                                                                                                                 NSN: 0052-00-682-5007
CHECK FLIGHT TIME!
Let’s not forget IV and V!
                 I
               DON’T
              FORGET!
                     INSTRUCTOR‟S
                   RECOMMENDATION

                          Instructor‟s Recommendation
       I have personally instructed the applicant and consider this person ready to take the test.

Date        Instructor’s Signature    (Print Name & Sign)         Certificate No:   Certificate Expires
                  DESIGNATED EXAMINER‟S
                           REPORT
                     Designated Examiner or Airman Certification Representative Report
       Student Pilot Certificate Issued ( Copy attached )
       I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirements
       of 14 CFR Part 61 for the certificate or rating sought.

       I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.

       I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards with the result indicated below.

                                Approved--Temporary Certificate Issued ( Original Attached )
                                Disapproved--Disapproval Notice Issued ( Original Attached )
Location of Test ( Facility, City, State )                                                                                       Duration of Test
                                                                                                                         Ground Simulator/FTD Flight

Certificate or Rating for Which Tested                                            Type(s) of Aircraft Used                                   Registration No.(s)

Date                   Examiner’s Signature             (Print Name & Sign)               Certificate No.               Designation No. Designation Expires


                           Evaluator‟s Record (Use For ATP Certificate and/or Type Ratings)
                                       Inspector                        Examiner                    Signature and Certificate Number                         Date
Oral
Approved Simulator/Training Device Check
Aircraft Flight Check
Advanced Qualification Program
                  DESIGNATED EXAMINER‟S REPORT


                    Designated Examiner or Airman Certification Representative Report
       Student Pilot Certificate Issued ( Copy attached )
       I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirements
       of 14 CFR Part 61 for the certificate or rating sought.

       I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.

       I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards, with the resul t indicated below.

                                Approved--Temporary Certificate Issued ( Original Attached )
                                Disapproved--Disapproval Notice Issued ( Original Attached )
Location of Test ( Facility, City, State )                                                                                              Duration of Test
                                                                                                                         Ground        Simulator/FTD            Flight

Certificate or Rating for Which Tested                                            Type(s) of Aircraft Used                                   Registration No.(s)

Date                  Examiner’s Signature              (Print Name & Sign)               Certificate No.               Designation No. Designation Expires


                          Evaluator‟s Record (Use For ATP Certificate and/or Type Ratings)
                                       Inspector                        Examiner                   Signature and Certificate Number                          Date
Oral
Approved Simulator /Training Device Check
Aircraft Flight Check
Advanced Qualification Program
       „I have personally reviewed … and certify…
             meets…requirements for FAR 61

                    Designated Examiner or Airman Certification Representative Report
       Student Pilot Certificate Issued ( Copy attached )
       I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirements
       of 14 CFR Part 61 for the certificate or rating sought.

       I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.

       I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards, with the resul t indicated below.

                                Approved--Temporary Certificate Issued ( Original Attached )
                                Disapproved--Disapproval Notice Issued ( Original Attached )
Location of Test ( Facility, City, State )                                                                                              Duration of Test
                                                                                                                         Ground        Simulator/FTD            Flight

Certificate or Rating for Which Tested                                            Type(s) of Aircraft Used                                   Registration No.(s)

Date                   Examiner’s Signature              (Print Name & Sign)              Certificate No.               Designation No. Designation Expires


                             Evaluator‟s Record (Use For ATP Certificate and/or Type Ratings)
                                       Inspector                        Examiner                   Signature and Certificate Number                          Date
Oral
Approved Simulator /Training Device Check
Aircraft Flight Check
Advanced Qualification Program
           “I have personally tested...in accordance
               with...procedures and standards...”


                    Designated Examiner or Airman Certification Representative Report
       Student Pilot Certificate Issued ( Copy attached )
       I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirements
       of 14 CFR Part 61 for the certificate or rating sought.

       I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.

       I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards, with the resul t indicated below.

                                Approved--Temporary Certificate Issued ( Original Attached )
                                Disapproved--Disapproval Notice Issued ( Original Attached )
Location of Test ( Facility, City, State )                                                                                              Duration of Test
                                                                                                                         Ground        Simulator/FTD            Flight

Certificate or Rating for Which Tested                                            Type(s) of Aircraft Used                                   Registration No.(s)

Date                   Examiner’s Signature              (Print Name & Sign)              Certificate No.               Designation No. Designation Expires


                             Evaluator‟s Record (Use For ATP Certificate and/or Type Ratings)
                                       Inspector                        Examiner                   Signature and Certificate Number                          Date
Oral
Approved Simulator /Training Device Check
Aircraft Flight Check
Advanced Qualification Program
                “Location of Test (Facility, City, State”
                        Facility=Airport Name

                    Designated Examiner or Airman Certification Representative Report
       Student Pilot Certificate Issued ( Copy attached )
       I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirements
       of 14 CFR Part 61 for the certificate or rating sought.

       I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.

       I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards, with the resul t indicated below.

                                Approved--Temporary Certificate Issued ( Original Attached )
                                Disapproved--Disapproval Notice Issued ( Original Attached )
Location of Test ( Facility, City, State )                                                                                              Duration of Test
                                                                                                                         Ground        Simulator/FTD            Flight

Certificate or Rating for Which Tested                                            Type(s) of Aircraft Used                                   Registration No.(s)

Date                   Examiner’s Signature              (Print Name & Sign)              Certificate No.               Designation No. Designation Expires


                             Evaluator‟s Record (Use For ATP Certificate and/or Type Ratings)
                                       Inspector                        Examiner                   Signature and Certificate Number                          Date
Oral
Approved Simulator /Training Device Check
Aircraft Flight Check
Advanced Qualification Program
           “Test Duration (Gnd / Sim/FTD / Aircraft),
               Cert or Rating, Type Aircraft, N#!


                    Designated Examiner or Airman Certification Representative Report
       Student Pilot Certificate Issued ( Copy attached )
       I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirements
       of 14 CFR Part 61 for the certificate or rating sought.

       I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.

       I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards, with the resul t indicated below.

                                Approved--Temporary Certificate Issued ( Original Attached )
                                Disapproved--Disapproval Notice Issued ( Original Attached )
Location of Test ( Facility, City, State )                                                                                              Duration of Test
                                                                                                                         Ground        Simulator/FTD            Flight

Certificate or Rating for Which Tested                                            Type(s) of Aircraft Used                                   Registration No.(s)

Date                   Examiner’s Signature              (Print Name & Sign)              Certificate No.               Designation No. Designation Expires


                             Evaluator‟s Record (Use For ATP Certificate and/or Type Ratings)
                                       Inspector                        Examiner                   Signature and Certificate Number                          Date
Oral
Approved Simulator /Training Device Check
Aircraft Flight Check
Advanced Qualification Program
                    BE COMPLETE AND EXACT IN THE
                         TYPE OF TEST GIVEN

                    Designated Examiner or Airman Certification Representative Report
       Student Pilot Certificate Issued ( Copy attached )
       I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirements
       of 14 CFR Part 61 for the certificate or rating sought.

       I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.

       I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards, with the resul t indicated below.

                                Approved--Temporary Certificate Issued ( Original Attached )
                                Disapproved--Disapproval Notice Issued ( Original Attached )
Location of Test ( Facility, City, State )                                                                                              Duration of Test
                                                                                                                         Ground        Simulator/FTD            Flight

Certificate or Rating for Which Tested                                            Type(s) of Aircraft Used                                   Registration No.(s)

Date                   Examiner’s Signature              (Print Name & Sign)              Certificate No.               Designation No. Designation Expires


                             Evaluator‟s Record (Use For ATP Certificate and/or Type Ratings)
                                       Inspector                        Examiner                   Signature and Certificate Number                          Date
Oral
Approved Simulator /Training Device Check
Aircraft Flight Check
Advanced Qualification Program
                 “Date” -- This is ALWAYS the date of
                   completion of the Practical Test!

                    Designated Examiner or Airman Certification Representative Report
       Student Pilot Certificate Issued ( Copy attached )
       I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirements
       of 14 CFR Part 61 for the certificate or rating sought.

       I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.

       I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards, with the resul t indicated below.

                                Approved--Temporary Certificate Issued ( Original Attached )
                                Disapproved--Disapproval Notice Issued ( Original Attached )
Location of Test ( Facility, City, State )                                                                                              Duration of Test
                                                                                                                         Ground        Simulator/FTD            Flight

Certificate or Rating for Which Tested                                            Type(s) of Aircraft Used                                   Registration No.(s)

Date                   Examiner’s Signature              (Print Name & Sign)              Certificate No.               Designation No. Designation Expires


                             Evaluator‟s Record (Use For ATP Certificate and/or Type Ratings)
                                       Inspector                        Examiner                   Signature and Certificate Number                          Date
Oral
Approved Simulator /Training Device Check
Aircraft Flight Check
Advanced Qualification Program
  ATP/TYPE RATING - COMPLETE BOTH SECTIONS

                    Designated Examiner or Airman Certification Representative Report
       Student Pilot Certificate Issued ( Copy attached )
       I have personally reviewed this applicant’s pilot logbook and/or training record, and certify that the individual meets the pertinent requirements
       of 14 CFR Part 61 for the certificate or rating sought.

       I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate.

       I have personally tested and/or verified this applicant or verified this applicant in accordance with pertinent procedures and standards, with the result indicated below.

                                Approved--Temporary Certificate Issued ( Original Attached )
                                Disapproved--Disapproval Notice Issued ( Original Attached )
Location of Test ( Facility, City, State )                                                                                             Duration of Test
                                                                                                                         Ground        Simulator/FTD Flight

Certificate or Rating for Which Tested                                            Type(s) of Aircraft Used                                   Registration No.(s)

Date                   Examiner’s Signature             (Print Name & Sign)               Certificate No.               Designation No. Designation Expires


                           Evaluator‟s Record (Use For ATP Certificate and/or Type Ratings)
                                        Inspector                       Examiner                    Signature and Certificate Number                         Date
Oral
Approved Simulator /Training Device Check
Aircraft Flight Check
Advanced Qualification Program
INSPECTOR‟S SIGNATURE




ORIGINAL CFI APPLICATIONS
                                  ATTACHMENTS
Attachments:                                    Airman’s Identification ( ID )   ID:
   Student Pilot Certificate ( copy ) PENNSYLVANIA DRIVER‟S LICENSE              Name:
                                            Form of ID
X Knowledge Test Report
                                                                                 Date of Birth:
                                             271346273
X Temporary Airman Certificate
X                                            Number
                                              12-13-2000                         Certificate Number:
   Notice of Disapproval                     Expiration Date
                                              940-484-9082                       E-mail Address
X Superseded Airman Certificate
                                             Telephone Number

FAA Form 8710-1 (4-00) Supersedes Previous Edition                                                          NSN: 0052-00-682-5007
                                                                                                       U.S.GPO:2000 520-137/95006
    UNITED STATES OF AMERICA              CERTIFICATE NO.
DEPARTMENT OF TRANSPORTATION
FEDERAL AVIATION ADMINISTRATION
                                          ZZ- 174727

   STUDENT PILOT CERTIFICATE
  THIS CERTIFIES THAT ( Full name and address )
     JETHRO BODINE
     3211 RODEO DRIVE
     BEVERLY HILLS, CA 96002
                                                    ZIP CODE
   BIRTH DATE      HEIGHT WEIGHT         HAIR        EYES        SEX
07-16-1950 76 IN 200 BLACK BLUE M
    Has met the standards prescribed in Part 61 of the Fed-
    eral Aviation Regulations for a Student Pilot Certificate.
     1. PASSENGER CARRYING IS PROHIBITED




      ISSUANCE DATE               EXPIRATION DATE
      05-15-2000                   05-31-2002
         Wiley E Post
     SIGNATURE OF EXAMINER OR INSPECTOR          EXAM. DESIG. NO.
                                                 OR INSPECTOR’S
                                                     REG. NO.

         WILEY E. POST                           SW-05-28
     DATE EXAMINER’S DESIG. EXPIRES:

               03-31-2001
  STUDENT PILOT’S
  SIGNATURE         Jethro Bodine
FAA Form 8710-2 (2-77) FORMERLY FAA FORM 8420-1
                    I. UNITED STATES OF AMERICA                                      III. CERTIFICATE NO.
    DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION

          ii .   TEMPORARY AIRMAN CERTIFICATE                                           284439812
     THIS CERTIFIES THAT            IV.
                                           ELAINE SUSAN OLEKSA
                                V.         419 SECOND STREET
                                           LOWELL, CT 01610
    DATE OF BIRTH       HEIGHT            WEIGHT     HAIR        EYES       SEX    NATIONALITY              VI.


    09-03-1946 68             IN.         126      BROWN BLUE                F         USA
      IX. has been found properly qualified and is hereby authorized in accordance with the conditions of issuance
          on the reverse of this certificate to exercise the privileges of

                                            RECREATIONAL PILOT
     RATINGS AND LIMITATIONS

     XII .       ROTORCRAFT - GYROPLANE


                 HOLDER DOES NOT MEET ICAO REQUIREMENTS
     XIII .

    THIS IS      X
             AN ORIGINAL ISSUANCE               A REISSUANCE DATE OF SUPERSEDED AIRMAN CERTIFICATE
    OF THIS GRADE OF CERTIFICATE

                                                                     07-16-1998
                                                                              EXAMINER’S DESIGNATION NO. OR
                 BY DIRECTION OF THE ADMINISTRATOR                            INSPECTOR’S REG. NO.


                                           Wiley E Post                      SW-05-28 / 255124567
    X. DATE OF ISSUANCE       X. SIGNATURE OF EXAMINER OF INSPECTOR
                                                                              DATE DESIGNATION EXPIRES
         06-20-2000                        WILEY E. POST                             03-31-2001
FAA FORM 8060-4 (8-79)USE PREVIOUS EDITION
                  I. UNITED STATES OF AMERICA                                       III. CERTIFICATE NO.
     DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION

     ii .    TEMPORARY AIRMAN CERTIFICATE                                             173239702
      THIS CERTIFIES THAT        IV.   LOIS ANN GARNER
                                V.
                                       123 NORTH SECOND STREET
                                       KIDD, PA 16236
    DATE OF BIRTH      HEIGHT        WEIGHT       HAIR          EYES       SEX     NATIONALITY             VI.

    07-27-1960 70 IN.                  135 BROWN BROWN F                             USA
     IX. has been found properly qualified and is hereby authorized in accordance with the conditions of issuance
          on the reverse of this certificate to exercise the privileges of

                                        PRIVATE PILOT
     RATINGS AND LIMITATIONS

     XII .
               AIRPLANE SINGLE ENGINE LAND

               RECREATIONAL PRIVILEGES
     XIII .    ROTORCRAFT - HELICOPTER
    THIS IS   X
             AN ORIGINAL ISSUANCE
    OF THIS GRADE OF CERTIFICATE
                                              A REISSUANCE   DATE OF SUPERSEDED AIRMAN CERTIFICATE


                                                                       07-16-1997
                                                                             EXAMINER’S DESIGNATION NO. OR
               BY DIRECTION OF THE ADMINISTRATOR                             INSPECTOR’S REG. NO.
    X. DATE OF ISSUANCE
                                       Wiley E Post
                              X. SIGNATURE OF EXAMINER OF INSPECTOR                SW-05-28
                                                                               DATE DESIGNATION EXPIRES

             06-11-2000                 WILEY E. POST                                03-31-2001
FAA FORM 8060-4 (8-79) USE PREVIOUS EDITION
                                                                                     2234167
        61.75
     U. S. CERTIFICATE

         COMBINE

FOREIGN BASED CERTIFICATE
           N8700.15 and Q & A
• APPLIES TO EVERY CONCEIVABLE CERTIFICATION FUNCTION
  INVOLVING A FOREIGN PILOT LICENSE
• DOES NOT APPLY TO ANY APPLICANT THAT COMPLETES ALL
  “STANDARD AIRMAN CERTIFICATION” REQUIREMENTS --
  ELIGIBILITY, KNOWLEDGE, PROFICIENCY, & EXPERIENCE (LIKE
  YOU AND I DID!)
• REQUIRES APPLICANT TO PRE-APPLY TO FAA FOR A
  “VERIFICATION OF AUTHENTICITY LETTER”
• BEFORE YOU CONDUCT ANY CERTIFICATION TESTING YOU MUST
  VERIFY THE APPLICANT IS IN POSSESSION OF AN ORIGINAL
  “VERIFICATION OF AUTHENTICITY LETTER” FROM FAA (THESE
  EXPIRE AFTER 60 DAYS!)
• YOU WILL COLLECT THIS LETTER AT THE TIME OF TESTING,
  CONDUCT TESTING, COMPLETE ALL PAPERWORK AND
  FORWARD EVERYTHING TO THE FSDO - YOU WILL NOT ISSUE
  THE TEMPORARY AIRMAN CERTIFICATE
• THE APPLICANT MUST APPEAR IN PERSON AT THE FSDO TO
  RECEIVE THEIR TEMPORARY CERTIFICATE
SEND PAPERWORK TO
FSDO WITHIN 5 DAYS!
?????
 ???
  ?
That’s all folks!

				
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