ASG-MFG-001 Aviation Safety Inspector (Manufacturing) Supplemental Q

AVIATION SAFETY INSPECTOR
(MANUFACTURING)
Supplemental Questionnaire

NAME: ________________________________________
SSN:

DATE: ____________________

________________________________________

Please circle the correct response and provide the information requested. This information will be
used to determine your eligibility for Aviation Safety Inspector (Manufacturing) positions.

1. I currently possess a valid state driver’s license.

Yes

No

2. I am able to communicate orally and in writing in the English
language.

Yes

No

3. I am a high school graduate, or I have an equivalency
certificate.

Yes

No

4. I have not had more than 2 separate incidents involving
Federal Aviation Regulations violations in the last 5 years.

Yes

No

6. I have a valid FAA mechanic certificate with airframe
and powerplant ratings.

Yes

No

7. I have a current private pilot certificate or higher pilot
certificate.

Yes

No

8. I have been employed by the FAA as an Aviation Safety
Inspector.

Yes

No

9. I have more than 10 years experience in the aviation field.

Yes

No

10. I have manufacturing work experience in both general
aviation and air carrier aircraft.

Yes

No

11. I have work experience in both the operations and
maintenance fields.

Yes

No

12. I have aviation investigative experience; e.g., field representative
for an aircraft manufacturer, aircraft accident investigator,
or legal investigator.

Yes

No

5. Circle your highest level of education.
a. No degree
c. Bachelor’s degree
b. Associate degree

d. Master’s/Doctorate degree

13. Circle the number of years of work experience you have in
establishing and/or implementing quality planning/inspection systems.
a. None
c. 5-9 years
b. 0-4 years

d. 10 or more years

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14. I have work experience as a quality supervisor/manager
at a facility which produces FAA-approved complete aircraft,
propellers, or class II products.

Yes

No

15. I have been involved in activities related to FAA
type certificate (TC) and/or supplemental type certificate (STC)
programs/projects or production approval programs.

Yes

No

16. I have work experience as a designated manufacturing
inspection representative (DMIR). If yes, list the issuing
MIDO location: ______________________________

Yes

No

Yes

No

Yes

No

19. I have work experience with software quality assurance
systems.

Yes

No

20. I have work experience with quality control for composite
materials/structures.

Yes

No

21. I have work experience with non-destructive inspection (NDI)
techniques.

Yes

No

22. I have work experience as a quality inspector on the flight
line at a facility which produces FAA type certificated products.

Yes

No

23. I have work experience with statistical process control (SPC)
applications.

Yes

No

24. I have been employed as a certificated mechanic or repairman
directly in charge of maintenance at a manufacturer’s
maintenance facility (MMF).

Yes

No

25. I have work experience in technical writing.

Yes

No

26. I have work experience with computer-aided
manufacturing/inspection systems or equipment.

Yes

No

27. I have work experience with the manufacture of
navigation or flight management systems.

Yes

No

28. I have work experience in auditing procurement
quality systems.

Yes

No

FAA DMIR No.: ______________________________
Date Issued:

______________________________.

17. I have work experience as a designated airworthiness
representative (DAR) in manufacturing. If yes, list the issuing
MIDO location: ______________________________
FAA DAR No.: ______________________________
Date Issued:

______________________________.

18. I have work experience as a delegation option
authorization (DOA) inspector. If yes, list the
Name of company: ______________________________
Assigned DOA No.: ______________________________
Date Issued:

______________________________.

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GEOGRAPHIC CODE LIST
Please select up to 9 geographic areas where you would like to be considered for employment. You will
only be referred for employment consideration for the geographic areas you select. You may select from
the list of regions and/or Manufacturing Inspection District Offices (MIDO’s) below. If you select
region(s), you may be referred for all locations within the region(s). If you mark more than 9 choices,
only the first 9 will be considered.
Central Region
Wichita, KS
Kansas City, MO

Northwest Mountain Region
Auburn, WA
Everett, WA
Lynwood, WA
Renton, WA
Seattle, WA

Eastern Region
Tetersboro, NJ
Farmingdale, NY
New Cumberland, PA

Southern Region
Mobile, AL
Orlando, FL
Atlanta, GA
Savannah, GA

Great Lakes Region
Chicago, IL
Detroit, MI
Minneapolis, MN
Cleveland, OH
Vandalia, OH

Southwest Region
Bethany, OK
Fort Worth, TX
San Antonio, TX

New England Region
Windsor Locks, CT
Burlington, MA

Western-Pacific Region
Phoenix, AZ
Long Beach, CA
Los Angeles, CA
Van Nuys, CA

PRIVACY ACT AND PUBLIC BURDEN STATEMENT

Public Law 104-50 allows the Federal Aviation Administration (FAA) to rate applicants for employment. We need the information on this
application questionnaire to see how well your education and work skills qualify you for employment with the FAA. We also need
information on matters such as citizenship and military service to see whether you are affected by laws we must follow in deciding whom
the Federal government may employ.
Executive Order 9397 authorizes the solicitation of your Social Security Number (SSN) for use as an identifier in personnel records
management to assure proper identification of applicants throughout the selection and employment process. The information we collect
on this questionnaire, including your SSN, will be used for employment purposes, and it may also be used for statistical studies or
computer matching with other government files. Furnishing your SSN or any of the other information requested in the vacancy
announcement is voluntary; however, failure to provide this information will prevent the processing of your application and will prevent your
consideration for employment. The nature of the information received is confidential, and authorized officials will handle it appropriately.
This information becomes part of a Privacy Act System of Records as identified in 5CFR 552a, under OPM/GOVT-1: General Personnel
Records.
We estimate it will take you 30 minutes or less to complete this form, including the time required to read the instructions, provide the
requested information, and review your responses. Send comments regarding this estimate or any other aspect of the collection of
information, including suggestions for reducing the burden, to the Federal Aviation Administration, Assistant Administrator for Human
Resource Management, 800 Independence Avenue, SW, Washington, D.C. 20591.

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