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FILES

FILES. ASI INDOC CLASS #8841. KELLY SWEETEN. DECEMBER 5, 2006. FILES. Processing Pilot & Flight Instructor Certification Files. OBJECTIVE:. NEWLY HIRED ASI’S WILL BE ABLE TO DEMONSTRATE THEIR ABILITY TO ACCURATELY PROCESS CERTIFICATION FILES. FILES.

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  1. FILES ASI INDOC CLASS #8841 KELLY SWEETEN DECEMBER 5, 2006

  2. FILES Processing Pilot & Flight Instructor Certification Files

  3. OBJECTIVE: NEWLY HIRED ASI’S WILL BE ABLE TO DEMONSTRATE THEIR ABILITY TO ACCURATELY PROCESS CERTIFICATION FILES.

  4. FILES A file return rate of greater than 5 files within 12 months from your CO is UNACCEPTABLE!!!

  5. FSDO AFS-760 PILOT EXAMINER APPLICANT

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

  7. COMMERCIAL SOFTWARE

  8. TYPE OR PRINT ALL ENTRIES IN INK Form Approved OMB No: 2120-0021 UNITED STATES OF AMERICAL DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION Airman Certificate and/or Rating Application I Application Information Instrument Student Recreational Private Commercial Airline Transport Balloon Airship Additional Rating Airplane Single-Engine Airplane Multiengine Rotorcraft Glider Powered Lift Additional Instructor Rating Ground Instructor Flight Instructor ____ Initial _____ Renewal ____ Reinstatement Reexamination Other _______________________ REISSUANCE of _______________Certificate Medical Flight Test APPLICATION INFORMATION

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

  10. A. Name (Last, First, Middle) B . SSN (US Only) C. Date of Birth D. Place of Birth Month Day Year G. Do you read, speak, write, & understand the English Language? E. Address F. CitizenshipSpecify USA Other____________ Yes No City, State, Zip Code H. Height I. Weight J. Hair L. Sex K. Eyes Male Female N. Grade Pilot Certificate O. Certificate Number P. Date Issued M. Do you now hold, or have you ever held an FAA Pilot Certificate Yes No Q. Do you hold a Medical Certificate? R. Class of Certificate S. Date Issued T. Name of Examiner Yes No V. Date of Final Conviction 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 PERSONAL INFORMATION & IDENTIFICATION DATA • A. Name (Last, First, Middle) • Legal name -- Maximum 3 names • No Middle Name -- “NMN” • Middle Initial Only -- “ Initial Only” • Jr. , II, etc. -- Indicate

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

  12. 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)

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

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

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

  16. A. Name (Last, First, Middle) B . SSN (US Only) C. Date of Birth D. Place of Birth Month Day Year G. Do you read, speak, write, & understand the English Language? E. Address F. CitizenshipSpecify USA Other____________ Yes No City, State, Zip Code H. Height I. Weight J. Hair L. Sex K. Eyes Male Female N. Grade Pilot Certificate O. Certificate Number P. Date Issued Yes No Q. Do you hold a Medical Certificate? R. Class of Certificate S. Date Issued T. Name of Examiner Yes No V. Date of Final Conviction 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 PERSONAL INFORMATION & IDENTIFICATION DATA • F. CITIZENSHIP • USA CHECKED • OR • CHECK OTHER & SHOW • COUNTRY OF CITIZENSHIP M. Do you now hold, or have you ever held an FAA Pilot Certificate

  17. A. Name (Last, First, Middle) B . SSN (US Only) C. Date of Birth D. Place of Birth Month Day Year G. Do you read, speak, write, & understand the English Language? E. Address F. CitizenshipSpecify USA Other____________ Yes No City, State, Zip Code H. Height I. Weight J. Hair L. Sex K. Eyes Male Female N. Grade Pilot Certificate O. Certificate Number P. Date Issued Yes No Q. Do you hold a Medical Certificate? R. Class of Certificate S. Date Issued T. Name of Examiner Yes No V. Date of Final Conviction 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 PERSONAL INFORMATION & IDENTIFICATION DATA • G. DO YOU READ, SPEAK, WRITE, & UNDERSTAND • THE ENGLISH LANGUAGE • MAKE SURE EITHER “YES” OR • “NO” HAS BEEN MARKED • THE APPLICANT’S OPINION M. Do you now hold, or have you ever held an FAA Pilot Certificate

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

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

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

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

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

  23. A. Name (Last, First, Middle) B . SSN (US Only) C. Date of Birth D. Place of Birth Month Day Year G. Do you read, speak, write, & understand the English Language? E. Address F. CitizenshipSpecify USA Other____________ Yes No City, State, Zip Code H. Height I. Weight J. Hair L. Sex K. Eyes Male Female N. Grade Pilot Certificate O. Certificate Number P. Date Issued M. Do you now hold, or have you ever held an FAA Pilot Certificate Yes No Q. Do you hold a Medical Certificate? R. Class of Certificate S. Date Issued T. Name of Examiner Yes No V. Date of Final Conviction 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 PERSONAL INFORMATION & IDENTIFICATION DATA • M. DO YOU NOW HOLD, OR HAVE EVER HELD AN FAA PILOT CERTIFICATE • ANSWER IS “NO” IF APPLICATION IS ON BASIS • OF FOREIGN LICENSE OR MILITARY COMPETENCE.

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

  25. A. Name (Last, First, Middle) B . SSN (US Only) C. Date of Birth D. Place of Birth Month Day Year G. Do you read, speak, write, & understand the English Language? E. Address F. CitizenshipSpecify USA Other____________ Yes No City, State, Zip Code H. Height I. Weight J. Hair L. Sex K. Eyes Male Female N. Grade Pilot Certificate O. Certificate Number P. Date Issued M. Do you now hold, or have you ever held an FAA Pilot Certificate Yes No Q. Do you hold a Medical Certificate? R. Class of Certificate S. Date Issued T. Name of Examiner Yes No V. Date of Final Conviction 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 PERSONAL INFORMATION & IDENTIFICATION DATA • O. CERTIFICATE NUMBER • COMPARE WITH THE • APPLICANT’S CERTIFICATE

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

  27. A. Name (Last, First, Middle) B . SSN (US Only) C. Date of Birth D. Place of Birth Month Day Year G. Do you read, speak, write, & understand the English Language? E. Address F. CitizenshipSpecify USA Other____________ Yes No City, State, Zip Code H. Height I. Weight J. Hair L. Sex K. Eyes Male Female N. Grade Pilot Certificate O. Certificate Number P. Date Issued M. Do you now hold, or have you ever held an FAA Pilot Certificate Yes No Q. Do you hold a Medical Certificate? R. Class of Certificate S. Date Issued T. Name of Examiner Yes No V. Date of Final Conviction 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 PERSONAL INFORMATION & IDENTIFICATION DATA • Q. DO YOU HOLD A MEDICAL CERTIFICATE? • ASSURE THAT AN • ANSWER IS MARKED

  28. A. Name (Last, First, Middle) B . SSN (US Only) C. Date of Birth D. Place of Birth Month Day Year G. Do you read, speak, write, & understand the English Language? E. Address F. CitizenshipSpecify USA Other____________ Yes No City, State, Zip Code H. Height I. Weight J. Hair L. Sex K. Eyes Male Female N. Grade Pilot Certificate O. Certificate Number P. Date Issued M. Do you now hold, or have you ever held an FAA Pilot Certificate Yes No Q. Do you hold a Medical Certificate? R. Class of Certificate S. Date Issued T. Name of Examiner Yes No V. Date of Final Conviction 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 PERSONAL INFORMATION & IDENTIFICATION DATA • R. CLASS OF CERTIFICATE? • ENTRY MUST BE CLASS • SHOWN ON THE CERTIFICATE • (FIRST, SECOND, THIRD)

  29. MINIMUM MEDICAL CERTIFICATE CLASS 1. Glider or Balloon - None 2. Sport Pilot – None (maybe) 3. Recreational Pilot - Third 4. Private Pilot - Third 5. Commercial Pilot - Third (CONT)

  30. MINIMUM MEDICAL CERTIFICATE CLASS 6.Airline Transport Pilot - Third 7. Instrument Rating - Third 8. Additional Category/Class - Third 9. Flight Instructor - None?

  31. A. Name (Last, First, Middle) B . SSN (US Only) C. Date of Birth D. Place of Birth Month Day Year G. Do you read, speak, write, & understand the English Language? E. Address F. CitizenshipSpecify USA Other____________ Yes No City, State, Zip Code H. Height I. Weight J. Hair L. Sex K. Eyes Male Female N. Grade Pilot Certificate O. Certificate Number P. Date Issued M. Do you now hold, or have you ever held an FAA Pilot Certificate Yes No Q. Do you hold a Medical Certificate? R. Class of Certificate S. Date Issued T. Name of Examiner Yes No V. Date of Final Conviction 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 PERSONAL INFORMATION & IDENTIFICATION DATA • S. DATE ISSUED T. NAME OF EXAMINER • CO SHOULD MAKE CERTAIN ENTRIES MATCH CERTIFICATE DURING THE CERTIFICATION PROCESS AS PART OF QC

  32. A. Name (Last, First, Middle) B . SSN (US Only) C. Date of Birth D. Place of Birth Month Day Year G. Do you read, speak, write, & understand the English Language? E. Address F. CitizenshipSpecify USA Other____________ Yes No City, State, Zip Code H. Height I. Weight J. Hair L. Sex K. Eyes Male Female N. Grade Pilot Certificate O. Certificate Number P. Date Issued M. Do you now hold, or have you ever held an FAA Pilot Certificate Yes No Q. Do you hold a Medical Certificate? R. Class of Certificate S. Date Issued T. Name of Examiner Yes No V. Date of Final Conviction 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 PERSONAL INFORMATION & IDENTIFICATION DATA • U. HAVE YOU EVER BEEN CONVICTED- - - - • NOT ALCOHOL RELATED • ASSURE THAT EITHER YES OR NO • HAS BEEN MARKED. • DATE OF FINAL CONVICTION IF YES

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

  34. III Record of Pilot time (Do not write in the shaded areas.) Pilot in Command (PIC) Night Instruction Received Number of Ground Launches Number of Powered Launches Cross Country Instruction Received Night Take-off/ Landing Night Takeoff/ Landing PIC Cross Country PIC Number of Flights Number of Aero-Tows Instruction Received Cross Country Solo Total Solo Instrument Night PIC PIC PIC PIC PIC Airplanes SIC SIC SIC SIC PIC PIC PIC PIC Rotor- craft SIC SIC SIC SIC PIC PIC PIC PIC Powered Lift SIC SIC SIC SIC Gliders Lighter than Air Simulator Training Device PCATD 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 III. RECORD OF PILOT TIME

  35. CHECK THE APPLICANT’S FLIGHT TIME AGAINST THE FAR’S

  36. LET’S NOT FORGETBLOCKS IV & V I DON’T FORGET!

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

  38. AIR AGENCY’S RECOMMENDATION Air Agency’s Recommendation This applicant has successfully completed our _____________________________________course, and is recommended for certification or rating without further ________________________________________test. Date Agency Name and Number Officials Signature Title

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

  40. ATP/TYPE RATING - CO’s MUST COMPLETE BOTH SECTIONS (NOT FOR FAA PERSONNEL) Designated Examiner or Airman Certification Representative 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 ) Duration of Test Location of Test ( Facility, City, State ) Ground Flight Simulator/FTD Registration No.(s) Certificate or Rating for Which Tested Type(s) of Aircraft Used Examiner’s Signature (Print Name & Sign) Certificate No. Designation No. Designation Expires Date Evaluator’s Record (Use For ATP Certificate and/or Type Ratings) Date Examiner Signature and Certificate Number Inspector Oral Approved Simulator/Training Device Check Aircraft Flight Check Advanced Qualification Program

  41. Attachments: Airman’s Identification ( ID ) Student Pilot Certificate ( copy ) PENNSYLVANIA DRIVER’S LICENSE ID: Name: Form of ID X Knowledge Test Report 271346273 Date of Birth: X Number Temporary Airman Certificate 12-13-2008 Certificate Number: Notice of Disapproval Expiration Date 940-484-9082 X E-mail Address Superseded Airman Certificate Telephone Number FAA Form 8710-1 (4-00) Supersedes Previous Edition U.S.GPO:2000 520-137/95006 NSN: 0052-00-682-5007 ATTACHMENTS

  42. COMMON ERRORS ON 8710-1 • FRONT OF APP: • Leaving the "SSN" block blank. It must have a SSN or show "None" or "Do not use". • "Place of Birth" needs a city as well as a state or country. We send it back if no city is shown. • 3. If the applicant has a previous airman record and he shows his name different from what was previously indicated. For example, our records show William Dale Smith, and he shows Will Dale Smith on the new application, we will send it back. This is a real problem with foreign applicants.

  43. COMMON ERRORS ON 8710-1 FRONT OF APP: 4. The drug statement MUST be answered. "U" under Part I, Application Information. 5. Under " II, Certificate or Rating Applied For on Basis of: Block A, 2a. "Total time in this aircraft/SIM/FTD" must show some time or show "0" hours. It cannot be left blank. (“Total time this aircraft means this make & model.) 6. If applicant is getting a U.S. certificate based on a foreign license, they MUST complete Part D, "Holder of Foreign License issued by", and they must have a “Verification of Authenticity” letter on file with the FSDO before arriving at the FSDO office.

  44. COMMON ERRORS ON 8710-1 FRONT OF APP: 7. If applying under Military Competency, Part B, "Military Competence Obtained In" must have 4a. completed. Some applicants put "yes". That is not what we are looking for...they must put the name of the aircraft flown. 8. In V, "Applicant's Certification", some foreign and military personnel put the day, month and year in the "date" field; they should put month first, day, year. Otherwise this can be confusing.

  45. COMMON ERRORS ON 8710-1 BACK OF APP: 9. In the DE report, in the "Location of Test", the city must be shown. For some reason, sometimes only the airport and state is given. (Of course, if it is a balloon or seaplane test, it would not be at an airport, so in that case, a city would not be shown.) 10. In the DE report, "Certificate or Rating for Which Tested" must show the entire rating, for instance, "flight instructor instrument airplane" not just "flight instructor" or "private pilot airplane single engine land", not just "Private pilot", etc.

  46. COMMON ERRORS ON 8710-1 BACK OF APP: 11. If the application is printed out on two separate sheets, the back of the application must show the identification of the applicant. This can be filled in at the lower right side of the BACK page under ID: 12. Be sure that the date on the temporary certificate is the date that the practical test was completed. The main objective is that the CO thoroughly check over the application in order to determine that all fields are completed correctly and that all signatures are there.

  47. AIRMAN CERTIFICATE (FRONT)

  48. AIRMAN CERTIFICATE (BACK)

  49. UNITED STATES OF AMERICA DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION CERTIFICATE NO. 174727 ZZ- STUDENT PILOT CERTIFICATE THIS CERTIFIES THAT ( Full name and address ) JETHRO LEROY BODINE 3211 RODEO DRIVE BEVERLY HILLS, CA 96002 ZIP CODE BIRTH DATE HEIGHT HAIR SEX WEIGHT EYES BLUE 76 BLACK M 07-16-1950 200 IN Has met the standards prescribed in Part 61 of the Federal Aviation Regulations for a Student Pilot Certificate. 1. PASSENGER CARRYING IS PROHIBITED ISSUANCE DATE EXPIRATION DATE 07-05-2005 07-31-2007 SIGNATURE OF EXAMINER OR INSPECTOR EXAM. DESIG. NO. OR INSPECTOR’S REG. NO. Wiley E Post WILEY E. POST SW-05-28 DATE EXAMINER’S DESIG. EXPIRES: 05-31-2006 Jethro Bodine STUDENT PILOT’S SIGNATURE FAA Form 8710-2 (2-77) FORMERLY FAA FORM 8420-1

  50. UNITED STATES OF AMERICA DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION XXXXXX XXXXXX CERTIFICATE NO. 174727 ZZ- STUDENT PILOT CERTIFICATE THIS CERTIFIES THAT ( Full name and address ) JETHRO LEROY BODINE 3211 RODEO DRIVE BEVERLY HILLS, CA 96002 ZIP CODE BIRTH DATE HEIGHT HAIR SEX WEIGHT EYES BLUE 76 BLACK M 07-16-1970 200 IN Has met the standards prescribed in Part 61 of the Federal Aviation Regulations for a Student Pilot Certificate. 1. PASSENGER CARRYING IS PROHIBITED FOR RECORD PURPOSES ONLY ISSUANCE DATE EXPIRATION DATE 11-07-2005 07-31-2007 SIGNATURE OF EXAMINER OR INSPECTOR EXAM. DESIG. NO. OR INSPECTOR’S REG. NO. Wiley E Post WILEY E. POST SW-05-28 DATE EXAMINER’S DESIG. EXPIRES: 05-31-2006 Jethro Bodine STUDENT PILOT’S SIGNATURE FAA Form 8710-2 (2-77) FORMERLY FAA FORM 8420-1

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