Faa Form 8710-1 - Airman Certificate And/or Rating Application Supplemental Information And Instructions Page 4
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4Instructor's Recommendation
I have personally instructed the applicant and consider this person ready to take the test.
Date
Instructor's Signature
(Print Name & Sign)
Certificate No:
Certificate Expires
Air Agency's Recommendation
The applicant has successfully completed our _________________________________________________________course, and is recommended for certification or rating
without further _____________________________________________test.
Date
Agency Name and Number
Officials Signature
Title
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)
Location of Test (Facility, City, State)
Duration of Test
Ground
Simulator/FTD
Flight
Certificate or Rating for Which Tested
Type(s) of Aircraft Used
Registration No.(s)
Date
Examiner's Signature
(Print Name & Sign)
Certificate No.
Designation No.
Designation Expires
Evaluator's Record (Use For ATP Certificate and/or Type Ratings)
Inspector
Examiner
Signature and Certificate Number
Date
Oral
_______________________________________________________________
__________________________
Approved Simulator/Training Device Check
_______________________________________________________________
__________________________
Aircraft Flight Check
_______________________________________________________________
__________________________
Advanced Qualification Program
_______________________________________________________________
__________________________
Aviation Safety Inspector or Technician Report
I have personally tested this applicant in accordance with or have otherwise verified that this applicant complies with pertinent procedures, standards, policies, and or
necessary requirements with the result indicated below.
Approved -- Temporary Certificate Issued (Original Attached)
Disapproved -- Disapproval Notice Issued (Original Attached)
Location of Test (Facility, City, State)
Duration of Test
Ground
Simulator/FTD
Flight
Certificate or Rating for Which Tested
Type(s) of Aircraft Used
Registration No.(s)
Student Pilot Certificate Issued
Certificate or Rating Based on
Flight Instructor
Ground Instructor
Examiner's Recommendation
Military Competence
Renewal
Accepted
Rejected
Foreign License
Reinstatement
Reissue or Exchange of Pilot Certificate
Approved Course Graduate
Instructor Renewal Based on
Special Medical test conducted -- report forwarded
Other Approved FAA Qualification Criteria
Activity
Training Course
to Aeromedical Certification Branch, AAM-330
Test
Duties and
Responsibilities
Training Course (FIRC) Name
Graduation Certificate No.
Date
Date
Inspector's Signature
(Print Name & Sign)
Certificate No.
FAA District Office
Attachments:
Airman's Identification (ID)
Student Pilot Certificate (Copy)
__________________________________________________
ID:
Form of ID
Name: _____________________________________________
Knowledge Test Report
__________________________________________________
Number
Date of Birth: _______________________________________
Temporary Airman Certificate
__________________________________________________
Expiration Date
Certificate Number: __________________________________
Notice of Disapproval
__________________________________________________
Telephone Number
E-Mail Address ______________________________________
Superseded Airman Certificate
FAA Form 8710-1 (4-00) Supersedes Previous Edition
NSN: 0052-00-682-5007
Electronic Version (Adobe)
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