FILES! Processing Pilot & Flight Instructor Certification Files.

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!!!

FAA FORM 8710-1 4-00 Number of Free Flights 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. TYPE OR PRINT ALL ENTRIES IN INK Form Approved OMB No: 2120-0021 Airman Certificate and/or Rating Application DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION I Application InformationStudentPrivateCommercialInstrument Other ___________________ Additional Rating Rotorcraft Reexamination Additional Instructor Rating Reissuance of ____________Certificate Medical Flight Test Powered-Lift BalloonAirplane Multiengine Airplane Single-Engine Ground Instructor Flight Instructor ____ Initial _____ Renewal ____ Reinstatement RecreationalAirline Transport A. Name (Last, First, Middle) B. SSN ((US Only) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? YesNo Q. Do you hold a Medical Certificate? Yes 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? No Yes C. Date of Birth Month Day Year D. Place of Birth F. Citizenship Specify USA Other________ H. HeightI. WeightJ. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G.Do you read, speak, write, & understand the English language? Yes No L. Sex Male Female P. Date Issued V. Date of Final Conviction II. Certificate or Rating Applied For on Basis of: A. Completion of Required Test B. Military Competence Obtained in C. Graduate of Approved Course D. Holder of Foreign License Issued By 1. Aircraft to be used (if flight test required) 2a. Total time in this aircraft/SIM/FTD 1. Service2. Date Rated 4a. Flown 10 hours as pilot in command in last 12 months in the following Military Aircraft. 1. Name and Location of Training Agency or Training Center 2. Curriculum From Which Graduated 1. Country2. Grade of License 4. Ratings hours 2b. Pilot in command hours 3. Rank or Grade and Service Number 1a. Certificate Number 3. Date 3. Number E. Completion of Air Carrier’s Approved Training Program 1. Name of Air Carrier 2. Date 3. Which Curriculum Initial Upgrade Transition Instrument Cross Country PIC Cross Country Solo Night Instr. Rec’d Night Take-off/ Landing Night PIC Night Takeoff/ Landing PIC Number of Flights Number of Aero-tows Number of Ground Launches Number of Powered Launches Cross Country Instruction Received Pilot in Comand (PIC) Total Instruction Received III Record of Pilot time ( Do not write in the shaded areas. ) Airplanes Rotorcraft Powered Lift Gliders Lighter Than Air Simulator 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 Training Device PCATD FAA Form 8710-1 (4-00) Supersedes Previous Edition NSN: 0052-00-682-5007 Airship Glider 4b. US Military PIC & Instrument check in last 12 months (List Aircraft. S o l o PIC SIC PIC SIC PIC SIC PIC SIC PIC SIC PIC SIC PIC SIC PIC SIC PIC SIC PIC SIC PIC SIC PIC SIC

APPLICATION INFORMATION TYPE OR PRINT ALL ENTRIES IN INK Form Approved OMB No: 2120-0021 Airman Certificate and/or Rating Application DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION I Application InformationStudentPrivateCommercialInstrument Other _______________________ Additional RatingRotorcraft Reexamination Additional Instructor Rating Reissuance of _______________CertificateMedical Flight Test Powered LiftGlider Airplane MultiengineAirplane Single-Engine Ground Instructor Flight Instructor ____ Initial _____ Renewal ____ Reinstatement Recreational Airline Transport Airship Balloon Lighter Than AirAircraft

A. Name(Last, First, Middle) B. SSN (US Only) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes 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? No Yes C. Date of Birth Month Day Year D. Place of Birth F. Citizenship Specify USA Other____________ H. HeightI. WeightJ. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write, & understand the English Language? Yes No L. Sex Male Female P. Date Issued V. Date of Final Conviction PERSONAL INFORMATION AND IDENTIFICATION DATA W

A. Name(Last, First, Middle) B. SSN (US Only) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes 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? No Yes Medical Statement: I have no known physical defect which makes me unable to pilot a glider or free balloon Signature C. Date of Birth Month Day Year D. Place of Birth F. Citizenship Specify USA Other____________ H. HeightI. WeightJ. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write & understand the English Language? Yes No L. Sex Male Female P. Date Issued V. Date of Final Conviction X. Date A. Name A. Name (Last, First, Middle) Legal name -- Maximum 3 names No Middle Name -- “NMN” Middle Initial Only -- “ Initial Only” Jr., II, etc. -- Indicate A. Name (Last, First, Middle) PERSONAL INFORMATION AND IDENTIFICATION DATA

A. Name(Last, First, Middle) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes 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? No Yes Medical Statement: I have no known physical defect which makes me unable to pilot a glider or free balloon Signature C. Date of Birth Month Day Year D. Place of Birth F. Citizenship Specify USA Other____________ H. Height. I. Weight. J. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write & understand the English Language? YesNo L. Sex Male Female P. Date Issued V. Date of Final Conviction X. Date PERSONAL INFORMATION AND IDENTIFICATION DATA B. SSN (US Only) MUST CONTAIN ONE OF THE FOLLOWING: “NONE” -- IF NEVER ISSUED. “DO NOT USE” U. S. SOCIAL SECURITY NUMBER IT IS NOT TO APPEAR ON AN “ORIGINAL ISSUANCE” AIRMAN CERTIFICATE. B. SSN (US Only)

NEW GUIDANCE CONCERNING CERTIFICATE NUMBERS (THIS AFFECTS ONLY THOSE APPLICANTS WHO CURRENTLY USE THEIR SS# AS THEIR CERTIFICATE #) DURING CERTIFICATION - IF THE APPLICANT WISHES TO REMOVE THEIR SSN FROM THEIR PILOT CERTIFICATE, AND CHANGE TO A UNIQUE NUMBER, YOU MAY DO SO - IT IS THE APPLICANT’S CHOICE. HOWEVER ALL INITIAL CFI CERTIFICATES WILL NOW BE ISSUED A UNIQUE CERTIFICATE NUMBER AND WILL CAUSE THE PILOT CERTIFICATE TO BE RE- ISSUED USING THE SAME UNIQUE CERTIFICATE NUMBER (LESS THE “CFI” SUFFIX)

NEW AIRMAN CERTIFICATE (FRONT)

NEW AIRMAN CERTIFICATE (BACK)

A. Name(Last, First, Middle) B. SSN (US Only) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes 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? No Yes Signature D. Place of Birth F. Citizenship Specify USA Other____________ H. Height. I. Weight. J. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write, & understand the English Language? YesNo L. Sex Male Female P. Date Issued V. Date of Final Conviction X. Date PERSONAL INFORMATION AND IDENTIFICATION DATA C. Date of Birth Month Day Year C. DATE OF BIRTH EIGHT DIGITS MONTH FIRST AGREES WITH OTHER DOCUMENTS

A. Name(Last, First, Middle) B. SSN (US Only) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes 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? No Yes Signature C. Date of Birth Month Day Year F. Citizenship Specify USA Other____________ H. HeightI. WeightJ. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write & understand the English Language? YesNo L. Sex Male Female P. Date Issued V. Date of Final Conviction X. Date D. Place of Birth CITY & STATE COUNTY & STATE IF CITY IS UNKNOWN CITY & COUNTRY IF OUTSIDE THE USA PERSONAL INFORMATION AND IDENTIFICATION DATA

A. Name(Last, First, Middle) B. SSN (US Only) E. Address (Please See Instructions Before Completing) City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes 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? No Yes Medical Statement: I have no known physical defect which makes me unable to pilot a glider or free balloon Signature C. Date of Birth Month Day Year D. Place of Birth F. Citizenship Specify USA Other____________ H. Height. I. Weight. J. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write & understand the English Language? YesNo L. Sex Male Female P. Date Issued V. Date of Final Conviction X. Date E. Address City, State, Zip Code E. Address PERMANENT MAILING ADDRESS P. O. BOX or RURAL ROUTE INCLUDE EXPLANATION FOR 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) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes No U. Have you ever been convicted for violation of any Federal or State statutes pertaining to narcotic drugs, marijuana, or depressant No Yes Signature C. Date of Birth Month Day Year D. Place of Birth H. HeightI. WeightJ. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write & understand the English Language? Yes No L. Sex Male Female P. Date Issued V. Date of Final Conviction X. Date PERSONAL INFORMATION AND IDENTIFICATION DATA Other____________ USA F. Citizenship Specify F. Citizenship USA CHECKED OR CHECK OTHER & SHOW COUNTRY OF CITIZENSHIP

A. Name(Last, First, Middle) B. SSN (US Only) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes 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? No Yes Medical Statement: I have no known physical defect which makes me unable to pilot a glider or free balloon Signature C. Date of Birth Month Day Year D. Place of Birth F. Citizenship Specify USA Other____________ H. HeightI. Weight J. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number L. Sex Male Female P. Date Issued V. Date of Final Conviction X. Date YesNo G. Do you read, speak, write & understand the English Language? G. Do you read, speak, write, & understand the English Language? MAKE SURE EITHER “YES” OR “NO” HAS BEEN MARKED THE APPLICANT’S OPINION PERSONAL INFORMATION AND IDENTIFICATION DATA

PERSONAL INFORMATION AND IDENTIFICATION DATA A. Name(Last, First, Middle) B. SSN (US Only) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes 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? No Yes Signature C. Date of Birth Month Day Year D. Place of Birth F. Citizenship Specify USA Other____________ I. Weight. J. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write & understand the English Language? YesNo L. Sex Male Female P. Date Issued V. Date of Final Conviction H. Height WHOLE INCHES CONVERT FROM METERS, ETC.

A. Name(Last, First, Middle) B. SSN (US Only) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes 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? No Yes Signature C. Date of Birth Month Day Year D. Place of Birth F. Citizenship Specify USA Other____________ H. HeightJ. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write & understand the English Language? YesNo L. Sex Male Female P. Date Issued V. Date of Final Conviction I. Weight WHOLE POUNDS CONVERT WHEN NECESSARY PERSONAL INFORMATION AND IDENTIFICATION DATA

A. Name(Last, First, Middle) B. SSN (US Only) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes 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? No Yes Signature C. Date of Birth Month Day Year D. Place of Birth F. Citizenship Specify USA Other____________ H. HeightI. WeightJ. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write & understand the English Language? Yes No L. Sex Male Female P. Date Issued V. Date of Final Conviction X. Date PERSONAL INFORMATION AND IDENTIFICATION DATA J. Hair SPELLED OUT BLACK, RED, BROWN, BLOND, GRAY, or BALD

A. Name(Last, First, Middle) B. SSN (US Only) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes 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? No Yes Signature C. Date of Birth Month Day Year D. Place of Birth F. (Citizenship) Specify USA Other____________ H. HeightI. WeightJ. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write & understand the English Language? Yes No L. Sex Male Female P. Date Issued V. Date of Final Conviction X. Date K. Eyes SPELLED OUT BLUE, BROWN, BLACK, HAZEL, GREEN, or GRAY PERSONAL INFORMATION AND IDENTIFICATION DATA

A. Name(Last, First, Middle) B. SSN (US Only) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes 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? No Yes Signature C. Date of Birth Month Day Year D. Place of Birth F. Citizenship Specify USA Other____________ H. HeightI. WeightJ. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write & understand the English Language? Yes No L. Sex Male Female P. Date Issued V. Date of Final Conviction X. Date PERSONAL INFORMATION AND IDENTIFICATION DATA L. Sex Male Female L. Sex MAKE SURE AN ANSWER IS MARKED PERSONAL INFORMATION AND IDENTIFICATION DATA

A. Name(Last, First, Middle) B. SSN (US Only) E. Address City, State, Zip Code Q. Do you hold a Medical Certificate? Yes 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? No Yes Medical Statement: I have no known physical defect which makes me unable to pilot a glider or free balloon Signature C. Date of Birth Month Day Year D. Place of Birth F. Citizenship Specify USA Other____________ H. HeightI. WeightJ. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write & understand the English Language? Yes No L. Sex Male Female P. Date Issued V. Date of Final Conviction PERSONAL INFORMATION AND IDENTIFICATION DATA M. Do you now hold, or have you ever held an FAA Pilot Certificate? YesNo M. Do you now hold, or have you ever held an FAA Pilot Certificate? ANSWER IS “NO” IF APPLICATION IS ON BASIS OF FOREIGN LICENSE OR MILITARY COMPETENCE.

A. Name(Last, First, Middle) B. SSN (US Only) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes 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? No Yes Signature C. Date of Birth Month Day Year D. Place of Birth F. Citizenship Specify USA Other____________ H. HeightI. WeightJ. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner O. Certificate Number G. Do you read, speak, write & understand the English Language? Yes No L. Sex Male Female P. Date Issued V. Date of Final Conviction X. Date N. Grade Pilot Certificate STUDENT, RECREATIONAL, PRIVATE, COMMERCIAL, OR ATP NOT FLIGHT INSTRUCTOR PERSONAL INFORMATION AND IDENTIFICATION DATA

A. Name(Last, First, Middle) B. SSN (US Only) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes 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? No Yes Signature C. Date of Birth Month Day Year D. Place of Birth F. Citizenship Specify USA Other____________ H. HeightI. WeightJ. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate G. Do you read, speak, write & understand the English Language? Yes No L. Sex Male Female P. Date Issued V. Date of Final Conviction X. Date PERSONAL INFORMATION AND IDENTIFICATION DATA O. Certificate Number COMPARE WITH THE APPLICANT’S CERTIFICATE. O. Certificate Number

A. Name(Last, First, Middle) B. SSN (US Only) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes 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? No Yes Signature C. Date of Birth Month Day Year D. Place of Birth F. Citizenship) Specify USA Other____________ H. HeightI. WeightJ. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write & understand the English Language? Yes No L. Sex Male Female V. Date of Final Conviction PERSONAL INFORMATION AND IDENTIFICATION DATA P. Date Issued AS SHOWN ON THE CERTIFICATE.

A. Name(Last, First, Middle) B. SSN (US Only) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes 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? No Yes Medical Statement: I have no known physical defect which makes me unable to pilot a glider or free balloon Signature C. Date of Birth Month Day Year D. Place of Birth F. Citizenship) Specify USA Other____________ H. Height. I. Weight. J. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write & understand the English Language? Yes No L. Sex Male Female P. Date Issued V. Date of Final Conviction PERSONAL INFORMATION AND IDENTIFICATION DATA Q. Do you hold a Medical Certificate? Yes No Q. Do you hold a Medical Certificate? ASSURE THAT AN ANSWER IS MARKED.

A. Name(Last, First, Middle) B. SSN (US Only) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes 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? No Yes Medical Statement: I have no known physical defect which makes me unable to pilot a glider or free balloon Signature C. Date of Birth Month Day Year D. Place of Birth F. Citizenship Specify USA Other____________ H. HeightI. WeightJ. HairK. Eyes S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write & understand the English Language? YesNo L. Sex Male Female P. Date Issued V. Date of Final Conviction PERSONAL INFORMATION AND IDENTIFICATION DATA R. Class of Certificate 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?

A. Name(Last, First, Middle) B. SSN (US Only) E. Address City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes 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? No Yes C. Date of Birth Month Day Year D. Place of Birth F. Citizenship Specify USA Other____________ H. HeightI. WeightJ. HairK. Eyes R. Class of Certificate N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write & understand the English Language? YesNo L. Sex Male Female P. Date Issued V. Date of Final Conviction PERSONAL INFORMATION AND IDENTIFICATION DATA S. Date Issued T. Name of Examiner S. Date IssuedT. Name of Examiner MAKE SURE ENTRIES MATCH CERTIFICATE

A. Name(Last, First, Middle) B. SSN (US Only) E. Address (Please See Instructions Before Completing) City, State, Zip Code M. Do you now hold, or have you ever held an FAA Pilot Certificate? Yes No Q. Do you hold a Medical Certificate? Yes No C. Date of Birth Month Day Year D. Place of Birth F. Citizenship Specify USA Other____________ H. HeightI. WeightJ. HairK. Eyes R. Class of Certificate S. Date IssuedT. Name of Examiner N. Grade Pilot Certificate O. Certificate Number G. Do you read, speak, write & understand the English Language? Yes No L. Sex Male Female P. Date Issued PERSONAL INFORMATION AND IDENTIFICATION DATA 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 U. Have you ever been convicted... ? NOT ALCOHOL RELATED ASSURE THAT EITHER YES OR NO HAS BEEN MARKED. DATE OF FINAL CONVICTION. V. Date of Final Conviction V. Date...

II. Certificate or Rating Applied For on Basis of: A. Completion of Required Test B. Military Competence Obtained in C. Graduate of Approved Course D. Holder of Foreign License Issued By 1. Aircraft to be used (if flight test required ) 1. Service2. Date Rated 4a. Flown10 hours PIC in last 12 months in the following Military Aircraft. 1. Name and Location of Training Agency of Training Center 2. Curriculum From Which Graduated 1. Country2. Grade of License 4. Ratings hours 2b. Pilot in command hours 3. Rank or Grade and Service Number 1a. Certificate Number 3. Date 3. Number E. Completion of Air Carrier’s Approved Training Program 1. Name of Air Carrier 2. Date 3. Which Curriculum Initial Upgrade Transition CERTIFICATE OR RATING APPLIED FOR ON BASIS OF: 4b. US Military PIC & Instrument check in last 12 months(List Aircraft) 2a. Total time in this aircraft / SIM / FTD

III RECORD OF PILOT TIME Instrument Cross Country PIC Cross Country Solo Night Instruction Received Night Take-off/ Landing Night PIC Night Takeoff/ Landing PIC Number of Flights Number of Aero-Tows Number of Ground Launches Number of Powered Launches Cross Country Instruction Received Pilot in Command (PIC) Solo Instruction Received Total III Record of Pilot time (Do not write in the shaded areas.) Airplane Lighter than Air Rotor- craft 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 FAA Form 8710-1 (4-00) Supersedes Previous Edition NSN: 0052-00-682-5007 Date Training Device Simulator PIC SIC PIC SIC PIC SIC PIC SIC Gliders Powered Lift PCATD

CHECK FLIGHT TIME!

Let’s not forget IV and V! I DON’T FORGET!

Instructor’s Recommendation I have personally instructed the applicant and consider this person ready to take the test. Date Certificate No:Certificate Expires INSTRUCTOR’S RECOMMENDATION Instructor’s Signature (Print Name & Sign)

DESIGNATED EXAMINER’S 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 ) Certificate or Rating for Which Tested Date Type(s) of Aircraft Used Certificate No. Registration No.(s) Duration of Test GroundFlight Designation No.Designation Expires Evaluator’s Record (Use For ATP Certificate and/or Type Ratings) Oral Approved Simulator/Training Device Check Aircraft Flight Check Inspector Examiner Date Simulator/FTD Advanced Qualification Program Designated Examiner or Airman Certification Representative Report Signature and Certificate Number Examiner’s Signature (Print Name & Sign)

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 ) Certificate or Rating for Which Tested Date Type(s) of Aircraft Used Certificate No. Registration No.(s) Duration of Test GroundFlight Designation No.Designation Expires Oral Approved Simulator /Training Device Check Aircraft Flight Check Inspector Examiner Date Advanced Qualification Program DESIGNATED EXAMINER’S REPORT Designated Examiner or Airman Certification Representative Report Evaluator’s Record (Use For ATP Certificate and/or Type Ratings) Examiner’s Signature (Print Name & Sign) Signature and Certificate Number Simulator/FTD

Student Pilot Certificate Issued ( Copy attached ) 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 ) Certificate or Rating for Which Tested Date Type(s) of Aircraft Used Certificate No. Registration No.(s) Duration of Test GroundFlight Designation No.Designation Expires Oral Approved Simulator /Training Device Check Aircraft Flight Check Inspector Examiner Date Advanced Qualification Program ‘I have personally reviewed … and certify… meets…requirements for FAR 61 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. Designated Examiner or Airman Certification Representative Report Simulator/FTD Examiner’s Signature (Print Name & Sign) Signature and Certificate Number Evaluator’s Record (Use For ATP Certificate and/or Type Ratings)

Student Pilot Certificate Issued ( Copy attached ) 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 ) Certificate or Rating for Which Tested Date Type(s) of Aircraft Used Certificate No. Registration No.(s) Duration of Test GroundFlight Designation No. Oral Approved Simulator /Training Device Check Aircraft Flight Check Inspector Examiner Date Advanced Qualification Program 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. Designated Examiner or Airman Certification Representative Report Simulator/FTD Examiner’s Signature (Print Name & Sign) Signature and Certificate Number Evaluator’s Record (Use For ATP Certificate and/or Type Ratings) “I have personally tested...in accordance with...procedures and standards...” Designation Expires

“Location of Test (Facility, City, State” Facility=Airport Name Student Pilot Certificate Issued ( Copy attached ) 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 ) Certificate or Rating for Which Tested Date Type(s) of Aircraft Used Certificate No. Registration No.(s) Duration of Test GroundFlight Designation No. Oral Approved Simulator /Training Device Check Aircraft Flight Check Inspector Examiner Date Advanced Qualification Program 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. Designated Examiner or Airman Certification Representative Report Simulator/FTD Examiner’s Signature (Print Name & Sign) Signature and Certificate Number Evaluator’s Record (Use For ATP Certificate and/or Type Ratings) Location of Test ( Facility, City, State ) Designation Expires

“Test Duration (Gnd / Sim/FTD / Aircraft), Cert or Rating, Type Aircraft, N#! Student Pilot Certificate Issued ( Copy attached ) 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 ) Certificate or Rating for Which Tested Date Type(s) of Aircraft Used Certificate No. Registration No.(s) Designation No. Oral Approved Simulator /Training Device Check Aircraft Flight Check Inspector Examiner Date Advanced Qualification Program 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. Designated Examiner or Airman Certification Representative Report Simulator/FTD Examiner’s Signature (Print Name & Sign) Signature and Certificate Number Evaluator’s Record (Use For ATP Certificate and/or Type Ratings) Duration of Test GroundFlight Designation Expires

BE COMPLETE AND EXACT IN THE TYPE OF TEST GIVEN Student Pilot Certificate Issued ( Copy attached ) 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 ) DateCertificate No. Duration of Test GroundFlight Designation No. Oral Approved Simulator /Training Device Check Aircraft Flight Check Inspector Examiner Date Advanced Qualification Program 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. Designated Examiner or Airman Certification Representative Report Simulator/FTD Examiner’s Signature (Print Name & Sign) Signature and Certificate Number Evaluator’s Record (Use For ATP Certificate and/or Type Ratings) Certificate or Rating for Which Tested Type(s) of Aircraft UsedRegistration No.(s) Designation Expires

“Date” -- This is ALWAYS the date of completion of the Practical Test! Student Pilot Certificate Issued ( Copy attached ) 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 GroundFlight Oral Approved Simulator /Training Device Check Aircraft Flight Check Inspector Examiner Date Advanced Qualification Program 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. Designated Examiner or Airman Certification Representative Report Simulator/FTD Signature and Certificate Number Evaluator’s Record (Use For ATP Certificate and/or Type Ratings) Certificate or Rating for Which Tested Type(s) of Aircraft UsedRegistration No.(s) DateCertificate No. Designation No. Examiner’s Signature (Print Name & Sign) Designation Expires

ATP/TYPE RATING - COMPLETE BOTH SECTIONS 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 ) Certificate or Rating for Which Tested DateExaminer’s Signature (Print Name & Sign) Type(s) of Aircraft Used Certificate No. Registration No.(s) Duration of Test GroundFlight Designation No.Designation Expires Evaluator’s Record (Use For ATP Certificate and/or Type Ratings) Oral Approved Simulator /Training Device Check Aircraft Flight Check Inspector Examiner Signature and Certificate Number Date Simulator/FTD Advanced Qualification Program Designated Examiner or Airman Certification Representative Report

INSPECTOR’S SIGNATURE ORIGINAL CFI APPLICATIONS

Student Pilot Certificate ( copy ) Knowledge Test Report Temporary Airman Certificate Airman’s Identification ( ID ) ID: Name: Date of Birth: Certificate Number: E-mail Address Attachments: X X PENNSYLVANIA DRIVER’S LICENSE 271346273 12-13-2000 ATTACHMENTS Notice of Disapproval Superseded Airman Certificate X Form of ID Number Expiration Date X Telephone Number 940-484-9082 FAA Form 8710-1 (4-00) Supersedes Previous Edition NSN: 0052-00-682-5007 U.S.GPO:2000 520-137/95006

COMMERCIAL SOFTWARE

05-15-2000 05-31-2002 1. PASSENGER CARRYING IS PROHIBITED CERTIFICATE NO. ZZ- 174727 UNITED STATES OF AMERICA DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION STUDENT PILOT CERTIFICATE THIS CERTIFIES THAT ( Full name and address ) ZIP CODE BIRTH DATEHEIGHT IN WEIGHTHAIR EYES SEX Has met the standards prescribed in Part 61 of the Fed- eral Aviation Regulations for a Student Pilot Certificate. ISSUANCE DATEEXPIRATION DATE SIGNATURE OF EXAMINER OR INSPECTOREXAM. DESIG. NO. OR INSPECTOR’S REG. NO. DATE EXAMINER’S DESIG. EXPIRES: STUDENT PILOT’S SIGNATURE FAA Form 8710-2 (2-77) FORMERLY FAA FORM 8420-1 JETHRO BODINE 3211 RODEO DRIVE BEVERLY HILLS, CA 96002 WILEY E. POST SW-05-28 03-31-2001 Jethro Bodine 07-16-1950 76200BLACK BLUE M Wiley E Post

I. UNITED STATES OF AMERICA DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION TEMPORARY AIRMAN CERTIFICATE ii. III. CERTIFICATE NO. THIS CERTIFIES THAT IV. V. DATE OF BIRTH HEIGHT IN. WEIGHTHAIR EYESSEXNATIONALITY VI. 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 RATINGS AND LIMITATIONS XII. XIII. THIS IS AN ORIGINAL ISSUANCE A REISSUANCE OF THIS GRADE OF CERTIFICATE DATE OF SUPERSEDED AIRMAN CERTIFICATE X. DATE OF ISSUANCEX. SIGNATURE OF EXAMINER OF INSPECTOR EXAMINER’S DESIGNATION NO. OR INSPECTOR’S REG. NO. DATE DESIGNATION EXPIRES USE PREVIOUS EDITIONFAA FORM 8060-4 (8-79) BY DIRECTION OF THE ADMINISTRATOR 284439812 ELAINE SUSAN OLEKSA 419 SECOND STREET LOWELL, CT 01610 09-03-1946 68 126 BROWN BLUE F USA 07-16-1998 06-20-2000 WILEY E. POST 03-31-2001 RECREATIONAL PILOT ROTORCRAFT - GYROPLANE X HOLDER DOES NOT MEET ICAO REQUIREMENTS Wiley E Post SW-05-28 / 255124567

I. UNITED STATES OF AMERICA DEPARTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION TEMPORARY AIRMAN CERTIFICATE ii. III. CERTIFICATE NO. THIS CERTIFIES THAT IV. V. DATE OF BIRTH HEIGHT IN. WEIGHTHAIR EYES SEXNATIONALITY VI. 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 RATINGS AND LIMITATIONS XII. XIII. THIS IS AN ORIGINAL ISSUANCE A REISSUANCE OF THIS GRADE OF CERTIFICATE DATE OF SUPERSEDED AIRMAN CERTIFICATE X. DATE OF ISSUANCEX. SIGNATURE OF EXAMINER OF INSPECTOR EXAMINER’S DESIGNATION NO. OR INSPECTOR’S REG. NO. DATE DESIGNATION EXPIRES USE PREVIOUS EDITIONFAA FORM 8060-4 (8-79) BY DIRECTION OF THE ADMINISTRATOR 173239702 LOIS ANN GARNER 123 NORTH SECOND STREET KIDD, PA 16236 07-27-1960 70 135 BROWN BROWN F USA 07-16-1997 03-31-2001 SW-05-28 PRIVATE PILOT AIRPLANE SINGLE ENGINE LAND X RECREATIONAL PRIVILEGES ROTORCRAFT - HELICOPTER 06-11-2000 WILEY E. POST Wiley E Post 2234167

61.75 U. S. CERTIFICATE COMBINE FOREIGN BASED CERTIFICATE

Home Site Map DOT Ask Search About The Registry Aircraft Registration Airmen Certification FAQ Home Search Site Map Useful Links Registry The Federal Aviation Administration’s (FAA’s) Civil Registration (AFS-700) is responsible for developing, maintaining, and operating national programs for the registration of United States civil aircraft certification of airmen. The Registry’s Aircraft Registration Branch (AFS-750) issues approximately 70,000 aircraft registration certificates and processes approximately 225,000 documents affecting title to or interest in aircraft engines, propellers, and air carrier spare part locations annually. Registry reserves and assigns all U.S. civil aircraft. The Registry maintains the permanent records of over Civil Aviation Registry Online N-Number Reservation Renewal

Home Site Map DOT Ask FAA Search About The Registry Aircraft Registration Airmen Certification FAQ Home Search Site Map Useful Links Registry Airmen Certification General Airmen Certification Information: PLEASE NOTE: We are currently processing permanent Airmen Certificates with an approximate issue date of September 25 th, 2003. Customer Service: ON-LINE SERVICES (establish your account, change your address Interactive Airmen Inquiry Web Site Hours of Operation Change Releasability Status of your Mailing Address Application for Replacement of Lost, Destroyed, or Paper Airman Certificate(s) and Knowledge Test Report(s) Copy of Your Airman Certification Records Update Your Address with FAA Replacement of Your Lost or Destroyed Knowledge Test Report Report a Change in Your Name, Nationality/Citizenship, Gender, or Verification of Authenticity of Foreign License, Rating, and Medical

Effective July 23, 2002, persons applying for a certificate issued on the basis of a foreign license under the provisions of 14 CFR Part 61, Section 61.75, special purpose pilot authorizations under Section 61.77, using a pilot certificate issued under Section 61.75 to apply for a commercial pilot certificate under Section 61.123 (h), applying for an airline transport pilot certificate issued under Section 61.153 (d) (3), and applying for a certificate issued on the basis of a foreign license under the provisions of 14 CFR Part 63, Sections 63.23 and 63.42, must have the validity and currency of the foreign license and medical certificate or endorsement verified by the Civil Aviation Authority (CAA) that issued those certificates, before making application for an FAA certificate or authorization. Please submit the required information using the optional FORM. Send the completed form with the preferred documents to the Airmen Certification Branch, AFS-760, PO BOX 25082, Oklahoma City, OK 73125-0082 or fax the form and documents to (405) 954-9922. The pre-application documents cannot be sent electronically. A person who is applying for a U.S. pilot certificate/rating on the basis of a foreign pilot license must apply for that pilot certificate at least 90 days before arriving at the designated FAA FSDO where the applicant intends to receive the U.S. pilot certificate. This initial application step is the responsibility of the applicantFORM The information submitted to the Airman Certification Branch by the applicant must include the following information: a. The name and date of birth of the applicant. Verification of Authenticity of Foreign License,Rating, and Medical Certificate

CONTINUE TO CHECK THE WEB SITE AND WITH YOU LOCAL FSDO FOR NEW GUIDANCE REGARDING FLIGHT TRAINING AND CERTIFICATION OF FOREIGN PILOTS

SEND PAPERWORK TO FSDO WITHIN 5 DAYS!

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FILES! Processing Pilot & Flight Instructor Certification Files.

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FILES! Processing Pilot & Flight Instructor Certification Files.

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