U.S. Department of Transportation Federal Aviation Administration INFORMATION FOR APPLICANT Application For An Airman Certificate and/or Rating Privacy Act Statement Information requested on this form is solicited under the authority of Title 49 of the United StatesCode(Transportation)sections109(9), 40113(a), 44701-44703, and 44709 (1994), formerly codified in the Federal Aviation Act of 1958, as amended, and Title 14 of the Code of Federal Regulations (CFR), Part 67, Medical Standards and Certification. Submission of this information is mandatory and incomplete submission will result in delay of consideration or denial of application for an airman medical certificate. The purpose of this information is to determine whether an applicant meets Federal Aviation Administration medical requirements to hold an airman medical certificate for further consideration under 14 CFR 11.53 and 67.401. It is also used to depict airman population patterns and to update certification procedures and medical standards. The information collected on this form becomes a part of the Privacy Act System of Records DOT/FAA 847, General Air Transportation Records on Individuals, and is provided the protection outlined in the system's description as published in the Federal Register. Paperwork Reduction Act Statement: The information collected on this form is necessary to determine applicant eligibility for flight engineer or flight navigator certificates. The information is used to determine certification eligibility. We estimated that it will take 6 minutes to complete the form. The information collection is required to obtain a benefit. The information collected becomes part of the Privacy Act system of records DOT/FAA 847, General Air Transportation Records on Individuals. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number associated with this collection is 2120-0007. Comments concerning the accuracy of this burden and suggestions for reducing the burden should be directed to the FAA at: 800 Independence Ave SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ABA-20 Tear off this cover sheet before submitting this form. FAA Form 8400-3 (1-98) Supersedes Previous Edition Electronic Version (Adobe) NSN: 0052-00-692-3002 American LegalNet, Inc. www.FormsWorkflow.com Form Approved OMB NO. 2120-0007 01/31/2008 U.S. Department of Transportation Federal Aviation Administration Application For An Airman Certificate and/or Rating Flight Navigator Reciprocating Engine Powered Aircraft Dispatcher Control Tower Operator Flight Engineer Reissuance of Certificate Turbopropeller Powered VFR Tower Rating Turbojet Powered Non-Radar Approach Control Tower Rating Additional Rating 3. NAME OF EMPLOYER 2. TIME IN THIS AIRCRAFT 1. TYPE OF AIRCRAFT TO BE USED 4. Applicant Identification A. NAME (First, Middle, Last) K. PERMANENT MAILING ADDRESS (Include Zip Code) B. SOCIAL SECURITY NO. H. SEX G. EYES F. HAIR I. NATIONALITY TELEPHONE NO. J. PLACE OF BIRTH 5. Certificates Held by Applicant A. Pilot B. Flight Navigator E. Ground Inspector Airline Transport Flight Instructor C. Control Tower Operator F. Aircraft Dispatcher Commercial Private D. Flight Engineer G. Mechanic 6. Applicant's Certification I certify that I meet all pertinent requirements of the Regulations for the certificate or rating applied for Instructor's Recommendation 7. I consider the above applicant ready to take the test for which he/she is applying: Date A. Oral Test Applicant's Signature C. Practical Test Aircraft Dispatcher or B. Flight D. Date Instructor's Signature Instructor's Certificate No. & Expiration Grade & Certificate No. Date E. Date Instructor's Signature Instructor's Certificate No. & Expiration Grade & Certificate No. Date 8. Evaluation Record Inspector Oral Examiner Signature Date Practical Test Aircraft Dispatcher Practical Test Control Tower Operator Simulator Check Aircraft Flight Check 9. Inspector's Record Temporary Airman Certificate Issued Notice of Disapproval of Application Issued INSPECTOR'S SIGNATURE DATE Examiner's Action Accepted FAA OFFICE REQ. OFFICE COM ISS ACT EMP TRN M.T. DIS CLASS SEX RATING STATE COUNTY Aircraft Dispatcher IFO Mailing Special Mailing CP Correspondence Airmail FAA Form 8400-3 (1-98) Supersedes Previous Edition Electronic Version (Adobe) NSN: 0052-00-692-3002 American LegalNet, Inc. www.FormsWorkflow.com Form Approved OMB NO. 2120-0007 01/31/2008 10. Practical Test Report Grading Legend (All applicable items must be graded S or U) Explain in ''Remarks'' all items which are not graded. S-Satisfactory, U-Unsatisfactory Equipment Examination (Oral) Preflight Inspection 1 2 3 4 5 6 7 Normal Operating Procedures Abnormal Operating Procedures Performance Data and Cruise Control Trouble Shooting Emergency Procedures Forms and Records Post Flight Crew Coordination Judgement Dispatch and Assistance Emergency Procedures Grade D. Control Tower Operator VFR TOWER RATING B. Flight Navigator Inspector Examiner Item No. Grade Equipment (Oral) Equipment Check Preflight Training 1 2 3 4 5 6 7 8 To The Control Tower The Airport The Control Zone Notice to Airmen Weather Facilities and Procedures A Demonstration of Ability to Control Air Traffic Under VFR 1 Night Air Navigation Facilities 3 4 5 6 7 8 Hours Day NON-RADAR APPROACH CONTROL TOWER RATING Air Traffic Control Facilities 2 11. Route of Flight Check From 1 2 3 4 5 6 Normal Navigation Procedures Knowledge of Navigation Methods Co-ordination of Navigational Methods Emergency Procedures Co-ordination of Duties Crew Coordination Judgement 9 10 Examiner Aircraft Air Routes and Airports Altimeters Weather Analysis Airman's Information Manual Inspector 9 10 11 Item No. 7 8 C. Aircraft Dispatcher Examiner 1 2 3 4 5 6 Item No. Inspector Examiner Item No. A. Flight Engineer Inspector Grade Grade Use of Airman's Information Manual Holding Procedures Approach Procedures Missed Approach Facilities Alternate Airports 9 10 Search and Rescue Procedures A Demonstration of Ability to Control Air Traffic Under IFR Airport Identification Airmans Identification (ID) Form of ID Number Expiration Date 10. Remarks FAA Form 8400-3 (1-98) Supersedes Previous Edition Electronic Version (Adobe) NSN: 0052-00-692-3002 American LegalNet, Inc. www.FormsWorkflow.com