Airman Certificate And/or Rating Application - Privacy Act Page 3

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Results of Oral and Practical Tests
MECHANIC
PARACHUTE RIGGER
I. GENERAL - Airframe and powerplant
SEAT
PASS
FAIL
EXPIRATION
ORAL TEST
PASS
FAIL
DATE:
BACK
PASS
FAIL
QUES.
NO.
CHEST
PASS
FAIL
EXPIRATION
PRACTICAL TEST
PASS
FAIL
LAP
PASS
FAIL
DATE:
PROJ.
NO.
PASS
FAIL
REMARKS
II. AIRFRAME STRUCTURES
EXPIRATION
ORAL TEST
PASS
FAIL
DATE:
QUES.
NO.
EXPIRATION
PRACTICAL TEST
PASS
FAIL
DATE:
PROJ.
NO.
III. AIRFRAME SYSTEMS AND COMPONENTS
EXPIRATION
ORAL TEST
PASS
FAIL
DATE:
QUES.
NO.
EXPIRATION
PRACTICAL TEST
PASS
FAIL
DATE:
PROJ.
NO.
IV. POWERPLANT THEORY AND MAINTENANCE
EXPIRATION
ORAL TEST
PASS
FAIL
DATE:
QUES.
NO.
EXPIRATION
PRACTICAL TEST
PASS
FAIL
DATE:
PROJ.
NO.
V. POWERPLANT SYSTEMS AND COMPONENTS
EXPIRATION
ORAL TEST
PASS
FAIL
DATE:
QUES.
NO.
EXPIRATION
PRACTICAL TEST
PASS
FAIL
DATE:
PROJ.
NO.
DESIGNATED EXAMINER'S REPORT
I have personally tested this applicant in accordance with pertinent procedures and standards, and
APPROVED (Temporary Certificate Issued)
APPROVED (Temporary Certificate NOT Issued)
I HAVE INDICATED
DISAPPROVED
FAR 65.80 - ORAL/PRACTICAL PASSED
THE RESULT AS:
REPORT OF WRITTEN TEST
SUPERSEDED CERTIFICATE
LETTER
ATTACH-
MENTS:
FAA FORM 8610-2
TEMPORARY CERTIFICATE
SEAL SYMBOL CARD
DATE TEST COMPLETED
EXAMINER'S SIGNATURE
DESIGNATION NO.
APPLICANT'S CERTIFICATION
APPLICANT'S CERTIFICATION
THIS BLOCK MUST BE COMPLETED BY THE APPLICANT AT THE TIME OF ISSUANCE OF TEMPORARY CERTIFICATE (FAA FORM 8060-4)
NO
Yes If "Yes," explain on an attached sheet.
A. HAVE YOU EVER HAD AN AIRMAN CERTIFICATE SUSPENDED OR REVOKED? . . . . . . . . . . . . . . .
DATE OF FINAL CONVICTION
B. HAVE YOU EVER BEEN CONVICTED FOR VIOLATION OF ANY FEDERAL OR STATES STATUTES
PERTAINING TO NARCOTIC DRUGS, MARIJUANA, DEPRESSANT OR STIMULANT
NO
YES
DRUGS OR SUBSTANCES? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I CERTIFY THAT THE STATEMENTS BY ME ARE TRUE.
B. DATE
A. SIGNATURE
FAA INSPECTOR'S REPORT
I HAVE -
WITH THE INDICATED RESULT -
PARACHUTE SEAL
EXAMINED THIS APPLICANT'S PAPERS.
APPROVED
SYMBOL ASSIGNED
ANSWER SHEET GRADED
PERSONALLY TESTED THIS APPLICANT IN
DISAPPROVED
(Military Competency)
ACCORDANCE WITH PERTINENT PROCEDURES
AND STANDARDS.
DATE
INSPECTOR'S SIGNATURE
FAA DISTRICT OFFICE
Electronic Version (Adobe)

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