Faa Form 8610-2 - Airman Cetificate And/or Rating Application - Privacy Act Page 2
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1
2
3Form Approved
TYPE OR PRINT ALL ENTRIES IN INK
2/28/2011
OMB. No. 2120-0022
U.S. Department of Transportation
Federal Aviation Administration
AIRMAN CERTIFICATE AND/OR RATING APPLICATION
REPAIRMAN
MECHANIC
REPAIRMAN
PARACHUTE RIGGER
PARACHUTE RIGGER
MECHANIC
AIRFRAME
SENIOR
MASTER
SENIOR
MASTER
AIRFRAME
SEAT
CHEST
POWERPLANT
CHEST
SEAT
POWERPLANT
(Specify Rating)
'
BACK
LAP
LAP
BACK
APPLICATION FOR:
ORIGINAL ISSUANCE
ADDED RATING
A. NAME (First, Middle, Last)
K. PERMANENT MAILING ADDRESS
B. SOCIAL SECURITY NO.
C. DOB (Mo., Day., Yr.)
D. HEIGHT
E. WEIGHT
NUMBER AND STREET, P.O. BOX, ETC.
IN.
F. HAIR
G. EYES
H. SEX
I. NATIONALITY (Citizenship)
CITY
J. PLACE OF BIRTH
STATE
ZIP CODE
L. HAVE YOU EVER HAD AN AIRMAN CERTIFICATE SUSPENDED OR REVOKED?
M. DO YOU NOW OR HAVE YOU EVER HELD AN FAA AIRMAN
CERTIFICATE?
NO
YES
NO
SPECIFY TYPE:
YES (If "Yes," explain on an attached sheet keying to appropriate item number).
N. HAVE YOU EVER BEEN CONVICTED FOR VIOLATION OF ANY FEDERAL OR STATE STATUTES
DATE OF FINAL CONVICTION
PERTAINING TO NARCOTIC DRUGS, MARIJUANA, AND DEPRESSANT OR STIMULANT
NO
YES
DRUGS OR SUBSTANCES? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
A. CIVIL
B. MILITARY
C. LETTER OF RECOMMENDATION FOR
EXPERIENCE
EXPERIENCE
REPAIRMAN (Attach copy)
(1) NAME AND LOCATION OF SCHOOL
D. GRADUATE
OF APPROVED
(2) SCHOOL NO.
(3) CURRICULUM FROM WHICH GRADUATED
(4) DATE
COURSE
E. STUDENT HAS MADE SATISFACTORY PROGRESS
(1) SCHOOL NAME
NO.
(2) SCHOOL OFFICIAL'S SIGNATURE
AND IS RECOMMENDED TO TAKE THE ORAL/
PRACTICAL TEST (FAR 65.80)
(1) DATE AUTH.
(2) DATE AUTH. EXPIRES (3) FAA INSPECTOR SIGNATURE
(4) FAA DIST OFC.
F. SPECIAL AUTHORIZATION TO TAKE
MECHANIC'S ORAL/PRACTICAL TEST
(FAR 65.80)
(1) SERVICE
(2) RANK OR PAY LEVEL
(3) MILITARY SPECIALITY CODE
A. MILITARY
COMPETANCE
OBTAINED IN
B. APPLICANT'S OTHER THAN FAA CERTIFICATED SCHOOL GRADUATES. LIST EXPERIENCE RELATING TO CERTIFICATE AND RATING APPLIED FOR.
(Continue on separate sheet, if more space is needed).
DATES: MONTH AND YEAR
EMPLOYER AND LOCATION
TYPE WORK PERFORMED
FROM
TO
FOR
PACKED AS A -
SEAT
CHEST
BACK
LAP
MASTER
C. PARACHUTE RIGGER APPLICANTS:
MILITARY
SENIOR
RATING
INDICATE BY TYPE HOW MANY
RIGGER
ONLY
RIGGER
PARACHUTES PACKED
I CERTIFY THAT THE STATEMENTS BY ME ON THIS APPLICATION ARE TRUE
IV. APPLICANT'S
A. SIGNATURE
B. DATE
CERTIFICATION
DATE
INSPECTOR'S SIGNATURE
FAA DISTRICT OFFICE
I FIND THIS APPLICANT MEETS THE EXPER-
V.
IENCE REQUIREMENTS OF FAR 65 AND IS
ELIGIBLE TO TAKE THE REQUIRED TESTS.
FOR FAA USE ONLY
Emp.
.reg.
D.O.
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#rte
Rating (1)
Rating (2)
Rating (3)
Rating (4)
LIMITATIONS
Electronic Version (Adobe)
FAA Form 8610-2
(2-85) SUPERSEDES PREVIOUS EDITION
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