Faa Form 8400-3 - Application For An Airman Certificate And/or Rating - Faa - 1998 Page 3
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1
2
3
4Form Approved
OMB NO. 2120-0007
0 /31/20
Application For An Airman Certificate and/or Rating
U.S. Department of Transportation
Federal Aviation Administration
Flight Navigator
Aircraft Dispatcher
Flight Engineer
Control Tower Operator
Reciprocating Engine Powered
Reissuance of Certificate
VFR Tower Rating
Additional Rating
Turbopropeller Powered
Non-Radar Approach Control
Turbojet
Tower Rating
Powered
3. NAME OF EMPLOYER
2. TIME IN THIS AIRCRAFT
1. TYPE OF AIRCRAFT TO BE USED
4. Applicant Identification
A. NAME
K. PERMANENT MAILING ADDRESS
(First, Middle, Last)
(Include Zip Code)
C. DATE OF BIRTH
D. HEIGHT
E. WEIGHT
B. SOCIAL SECURITY NO.
H. SEX
F. HAIR
G. EYES
I. NATIONALITY
TELEPHONE NO.
J. PLACE OF BIRTH
5. Certificates Held by Applicant
A.
Pilot
B. Flight Navigator
E. Ground Inspector
C. Control Tower Operator
F. Aircraft Dispatcher
Airline Transport
Flight Instructor
Commercial
Private
D. Flight Engineer
G. Mechanic
6. Applicant's Certification I certify that I meet all pertinent
requirements of the Regulations for the certificate or
rating applied for
Date
Applicant's Signature
Instructor's Recommendation
A. Oral Test
C. Practical Test
or
7. I consider the above applicant ready to take
Aircraft Dispatcher
B. Flight
the test for which he/she is applying:
Instructor's Signature
D. Date
Instructor's Certificate No. & Expiration
Grade & Certificate No.
Date
E. Date
Instructor's Signature
Instructor's Certificate No. & Expiration
Grade & Certificate No.
Date
8. Evaluation Record
Inspector
Examiner
Signature
Date
Oral
Practical Test
Aircraft Dispatcher
Practical Test
Control Tower Operator
Simulator Check
Aircraft Flight Check
9. Inspector's Record
Temporary Airman Certificate
Notice of Disapproval of Application Issued
Examiner's Action Accepted
Issued
INSPECTOR'S SIGNATURE
FAA OFFICE
DATE
Aircraft Dispatcher
IFO Mailing
CP
REQ.
OFFICE
COM ISS
ACT
EMP
TRN M.T. DIS
CLASS
SEX
RATING
STATE
COUNTY
Special Mailing
Correspondence
Airmail
FAA Form 8400-3
Electronic Version (Adobe)
NSN: 0052-00-692-3002
(1-98) Supersedes Previous Edition
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