Form 8710 Airman Certificate And Rating Application (Page 2 of 4) in pdf

AIRMAN CERTIFICATE AND/OR RATING APPLICATION

INSTRUCTIONS FOR COMPLETING FAA FORM 8710-1

Block T. Name of Examiner.

APPLICATION INFORMATION

As shown on the medical

Check appropriate block(s).

certificate.

Block A. Name.

Enter legal name but no more than one middle

Block U. Narcotics, Drugs, Alcohol.

name for record purposes and do not change the name on subsequent

Check appropriate

applications unless it is done in accordance with FAR Section 61.25. If

block. This should be checked "Yes" only if you have been actually

you have no middle name, enter "NMN." If you have a middle initial

convicted. If you have been charged with a violation which has not

only, indicate "Initial only." If you are a Jr., or a 2nd or 3rd, so indicate.

been adjudicated, check "No."

If you have an FAA pilot certificate, the name on the application

Block V.

should be the same as the name on the certificate unless you have

If block "U" was checked "Yes" give the date of final

had it changed in accordance with FAR Section 61.25.

conviction.

Block W.

Block B. Social Security Number.

Optional: See supple-

Glider or free balloon pilots should sign the medical

mental Information Privacy Act. Do not leave blank: Enter either SSN

certification in this block, if you do not hold a medical certificate. If

or the words "Do not use" or "None."

you hold a medical certificate, be sure Blocks Q, R, S, and T are

completed.

Block X. Date.

Block C. Date of Birth.

Check for accuracy. Enter six digits: Use

Date you sign this self-certification statement.

numeric characters, i.e.; 07-09-25 instead of July 9, 1925. Check to

see that DOB is the same as it is on the medical certificate.

II.

CERTIFICATE OR RATING APPLIED FOR ON BASIS OF

Block A. Completion of Required Test.

Block D. Place of Birth.

If you were born in the USA, enter the

AIRCRAFT TO BE USED (If flight test required) —Make and

city and state where you were born. If the city is unknown, enter the

model. If more than one aircraft is to be used, indicate such.

county and state. If you were born outside the USA, enter the name of

TOTAL TIME IN THIS AIRCRAFT TYPE (Hrs.) —(a) Total

the city and country where you were born.

Flight Time - In each make and model. (b) Pilot-ln-Command

Flight Time - In each make and model.

Block E. Permanent Mailing Address.

The residence

Block B. Military Competence Obtained In.

number and street, or when applicable, P.O. Box or rural route number

Enter your

goes in the top part of the block above the line. The City, State, and

branch of service, date rated as a military pilot, your rank or grade

ZIP code go in the bottom part of the block below the line. Check for

and service number, and the military aircraft in which you have

accuracy. Make sure the numbers are not transposed. FAA policy

flown 10 hours as pilot in command in the last 12 months in the

requires that you use your permanent mailing address. Justitication

boxes indicated.

must be provided on a separate sheet of paper and submitted

Block C. Graduate of Approved Course.

with the application when a P.O. Box or rural route number is

used in place of your permanent address.

NAME AND LOCATION OF TRAINING AGENCY / CENTER.

As shown on the graduation certificate. Be sure the location is

Block F. Nationality.

Check USA if applicable. If not, enter the

entered.

country where you are a citizen.

AGENCY SCHOOL/CENTER CERTIFICATION NUMBER. As

shown on the graduation certificate.

Block G. Do You Read, Speak, and Understand English?

CURRICULUM FROM WHICH GRADUATED. As shown on

Check yes or no.

the graduation certificate.

DATE. Date of graduation from indicated course. Approved

. Enter your height in inches. Example: 5'9" should

Block H. Height

course graduate must also complete Block "A" COMPLETION

be entered as 69 in. No fractions. Whole inches only.

OF REQUIRED TEST.

Block 1. Weight.

Block D. Holder of Foreign License Issued By.

Enter your weight in pounds. No fractions. Whole

pounds only.

1. COUNTRY. Country which issued the license.

2. GRADE OF LICENSE. Grade of license issued, i.e., private,

. Spell out the color of your hair. If bald, enter "Bald."

Block J. Hair

commercial, etc.

Color should be listed as black, red, brown, blond, or gray. If you wear

3. NUMBER. Number which appears on the license.

a wig or toupee, enter the color of your hair under the wig or toupee.

4. RATINGS. All ratings that appear on the license.

Block K. Eyes.

Block E. Completion of Air Carrier's Approved

Spell out the color of your eyes. The color should

Training Program

be listed as blue, brown, black, hazel, green, or gray.

1. Name of Air Carrier

Block L. Sex.

Check male or female.

2. Date program was completed.

Block M. Do You Now Hold or Have You Ever Held An

FAA Pilot Certificate?

Check yes or no. (NOTE: A student pilot

3. Identify the Training Cirriculum

certificate is a "Pilot Certificate.")

Record of Pilot Time.

III.

The minimum pilot experience

Block N. Grade Pilot Certificate.

Enter the grade of pilot

required by the appropriate regulation must be entered. It is

certificate (i.e., Student, Recreational, Private, Commercial, or ATP).

recommended, however, that ALL pilot time be entered. If decimal

Do NOT enter flight instructor certificate information.

points are used, be sure they are legible. Night flying must be

entered when required. You should fill in the blocks that apply, and

Block O. Certificate Number.

Enter the number as it appears

ignore the blocks that do not. Training Device/Simulator. Total,

on your pilot certificate.

instruction received, and Instrument Time should be entered in the

top or bottom half of the boxes provided as appropriate.

Block P. Date Issued.

Date your pilot certificate was issued.

Have You Failed A Test For This Certificate or

IV.

Block Q. Do You Now Hold A Medical Certificate?

Rating Within The Past 30 Days?

Check

Check appropriate

yes or no. If yes, complete Blocks R, S, and T.

blocks.

Block R. Class of Certificate.

Applicant's Certification.

Enter the class as shown on the

medical certificate, i.e., 1 st, 2nd, or 3rd class.

A. SIGNATURE. The way you normally sign your name.

Block S. Date Issued.

Date your medical certificate was issued.

B. DATE. The date you sign the application.

FAA Form 8710-1

NSN: 0052-00-682-5006

(7-95) Supersedes Previous Edition

Form 8710 Airman Certificate And Rating Application Page 2

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