Form Approved OMB No. 2120-0033 04/30/2014 APPLICATION AND STATEMENT OF QUALIFICATION (DME/DPRE/DAR-T) U.S. Department of Transportation Federal Aviation Administration Supplemental Application and Instructions See Privacy Act Information below. Paperwork Reduction Act Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2120-0033. Public reporting for this collection of information is estimated to be approximately 55 minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are required to obtain benefits by 14 CFR Part 183. 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, ASP-110. Detach all supplemental information and instruction sheets before submitting application. DESIGNEE/EXAMINER CANDIDATE APPLICATION PROCEDURES HOW TO APPLY For Initial Designations: 1. Complete, sign, and date this application. Complete all applicable blocks fully. Use additional sheets of blank paper if you need more space to complete the answers to a block. Be sure to indicate the number of the block you are answering at the top of the blank sheet. 2. Use a separate sheet for each block requiring additional space. Attach all additional blank sheets to this application. 3. Block 7. See definitions and qualification criteria on page ii of these instructions. 4. Applicants for DAR-T designations must attach a letter of recommendation in accordance with FAA Order 8100.8 latest revision, Designee Management Handbook. WHERE TO SEND APPLICATION FOR INITIAL DESIGNATION 1. Your completed application with all attached sheets should be sent to: Federal Aviation Administration Designee Standardization Branch, AFS-640 ATTN: National Examiner Board P.O. Box 25082 Oklahoma City, OK 73125-0082 2. Keep a copy of this application for your personal records. WHAT HAPPENS TO YOUR APPLICATION Your application will be e valuated by the National Examiner Board (NEB) to ensure that you meet the selection criteria for the designation sought. The NEB will advise you by letter whether or not you meet the applicable criteria. If you meet this criteria, the letter from the NEB will state that your application has been accepted an d instruct you to complete the examiner predesignation knowledge t est. If you do not meet the selection criteria, the NEB will advise you how the deficiency may be corrected. Do not take the predesignation knowledge test until receiving a letter of acceptance from the NEB. DAR-T's applicants are not required to take a predesignation test. Upon receiving notification that your application has been accepted, take the appropriate predesignation knowledge test at any FAA computerized testing center. Request the Aviation Mechanic Examiner Test or the Parachute Rigger Examiner Test. You must forward test results to the NEB within 10 days of the date you complete the test. Keep a copy of the test report for your personal records. Upon receiving the applicant's test report with a score of 80 percent or higher, the NEB will notify the applicant of approval/non-approval f or assignment to the national examiner candidate pool. In accordance with candidates' indicated geographic availability, qualifications, and ranking within the pool, the NEB forwards candidate applications to each FSDO requesting a new designee. Your application will be kept on file in the NEB candidate pool for a period of 2 years or until you are selected for designation, whichever comes first. After 2 years, applications of all candidates not selected for designation will be deleted from the NEB pool. An applicant must repeat the application process in order to apply for reassignment to the candidate pool. FAA Form 8110-28 (1/13) SUPERSEDES PREVIOUS EDITION i American LegalNet, Inc. www.FormsWorkFlow.com DESIGNEES/EXAMINERS APPLYING FOR RENEWAL, DESIGNEES/EXAMINERS APPLYING FOR RENEWAL, ADDITIONAL ADDITIONAL AUTHORIZATIONS, AND/OR REINSTATEMENTS. AUTHORIZATIONS, AND/OR REINSTATEMENTS. Information on this form is solicited under authority of 14 CFR Part 183. The information is used in the process of renewal, authorizations and/or reinstatements of Designees/Examiners with the FAA. Submission of the data is required. Incomplete submission may result in delay or denial of your request. The data will be used to determine your eligibility and will become part of the Privacy Act system of records DOT/FAA 830, Representatives of the Administrator, and is subject to the following routine uses as published in the Federal Register: (1) To provide the public with the names and addresses of certain categories of representatives who may provide service to them; and (2) DOT's Prefatory Statement of General Routine Uses. DISCLOSURE: Provision of the requested information is voluntary; however failure to furnish the requested information may result in an inability of the Department to renew your delegated authority. Privacy Act Statement FAA Form 8110-28 (1/13) SUPERSEDES PREVIOUS EDITION ii American LegalNet, Inc. www.FormsWorkFlow.com Form Approved OMB No. 2120-0033 04/30/2014 Designees/Examiners applying for renewal, additional authorizations, or reinstatement should complete blocks 1, 2, 4, 5, 6, 7, 7b (if applicable), 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, and 23a, and return it directly to the designating FSDO. Renewal applications shall be submitted to the designating FSDO 45 days before the designee's/examiner's current designation expires. TYPES OF DESIGNATIONS AND QUALIFICATION CRITERIA Definition DME - Designated Mechanic Examiner General Qualifications The applicant must: 1. Have held a valid aviation mechanic certificate for 5 years with the rating(s) for which designation is to be issued. 2. Have been actively exercising the privileges of a valid aviation mechanic certificate for 3 years immediately prior to designation. 3. Be at least 23 years of age. 4. Show evidence of a high level of aeronautical knowledge in