US Department of Transportation Federal Aviation Administration ROTORCRAFT EXTERNAL-LOAD OPERATOR CERTIFICATE APPLICATION Paperwork Reduction Act Statement: The information collected on this form is solicited in order to comply with Title 14, Code of Federal Regulations, Part 133. This information is used to establish eligibility for the issuance of the Rotorcraft External-Load Operator Certificate. Confidentiality is neither requested nor provided. We estimate that it will take approximately 0.3 hours to complete the form. 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 connection is 2120-0044. 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 SUPPLEMENTAL INFORMATION TEAR OFF BEFORE USE FAA Form 8710-4 (6-84) THIS PART SUPERSEDES FAA FORM 8000-32 DETACH THIS PART BEFORE USING FORM BELOW Electronic Version (Adobe) American LegalNet, Inc. www.FormsWorkflow.com Form Approved: OMB No. 2120-0044 09/30/2008 US Department of Transportation Rotorcraft External-Load Operator Certificate Application Federal Aviation Administration INSTRUCTIONS: Submit this form in triplicate to local FAA District Office 1. APPLICATION FOR (CHECK APPLICABLE BOX) CERTIFICATE NO. (For amendment or renewal only.) ORIGINAL ISSUANCE EXTERNAL - LOAD CLASS AUTHORIZATION (S) AMENDMENT A RENEWAL 2. NAME AND ADDRESS OF APPLICANT (Include Zip Code) C 3. PRINCIPAL OR LOCAL BASE OF OPERATIONS (Airport, City, State, and Zip Code) TELEPHONE NUMBER TELEPHONE NUMBER 4. NAME OF CHIEF PILOT OR PILOT IN CHARGE OF LOCAL OPERATION AIRMAN CERTIFICATE 5. B GRADE NUMBER ROTORCRAFT TO BE USED TYPE REGISTRATION NUMBER MAKE LOAD CLASS (X) MODEL A B C ATTACH PREV DEVICE APPD. YES NO REMARKS CERTIFICATION I certify that the statements made on this application form and any attachments are true and correct, and that the operations indicated on this application will be conducted within the requirements of the Federal Aviation Act of 1958 and the applicable Federal Aviation Regulations. DATE FAA Form 8710-4 TITLE OF AUTHORIZED OFFICER (6-84) SUPERSEDES FAA FORM 8420-7 and FAA FORM 8000-32 SIGNATURE OF APPLICANT OR AUTHORIZED OFFICER Electronic Version (Adobe) American LegalNet, Inc. www.FormsWorkflow.com INSPECTION REPORT (To be completed by FAA District Office Representative) ROTORCRAFT MAKE MODEL REGISTRATION NUMBER APPROVAL DATE CLASS LIMITATIONS AND REMARKS WEIGHT AUTHORIZED INSPECTOR'S SIGNATURE REMARKS CHIEF PILOT KNOWLEDGE AND SKILL REQUIREMENTS MET BY: NAME OF CHIEF PILOT CLASS A CLASS B CLASS C APPLICATION DISAPPROVED FAA DISTRICT OFFICE CLASS B SIGNATURE OF INSPECTOR CERTIFICATE NUMBER Applicant is Fully Qualified to Conduct External - Load Operations in Class (es) CLASS A DATE ISSUED ON CLASS C REASONS: SIGNATURE OF SUPERVISING INSPECTOR Electronic Version (Adobe) American LegalNet, Inc. www.FormsWorkflow.com