8610-2 Airman Certificate and/or Rating Application

TEAR OFF
BEFORE USE

U.S. Department of Transportation
Federal Aviation Administration

SUPPLEMENTAL
INFORMATION

AIRMAN CERTIFICATE AND/OR RATING APPLICATION - PRIVACY ACT

This supplements the form appearing below, Airman Certificate and/or Rating Application.

The information on the form is solicited under authority of Federal Aviation Regulations, Part 65.
Submission of all the data is mandatory except for Social Security Account Number which Is voluntary.
The purpose of this information is to establish eligibility for certification and/or airman rating.
The data will be used to identify and evaluate your qualifications and eligibility for the issuance of an airman
certificate and/or rating.
Certification cannot be completed unless the data is complete.
Disclosure of your Social Security Account Number is optional: Disclosure will facilitate maintenance of your
records which are maintained in alphabetical order and cross referenced with your SSAN and airman number to
provide prompt access. In the event of nondisclosure a unique number will be assigned to your file.
Paperwork Reduction Act Statement: The information collected on this form is necessary to ensure applicant eligibility. The information is used to
determine that the applicant meets the necessary qualifications as a Mechanic, Repairman, or Parachute Rigger. We estimate that it will take
approximately 20 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, Aviation Records on Individuals. Please not 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 2120-0022. 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.
FAA Form 8610-2 (2-85)

Electronic Version (Adobe)

Form Approved
OMB. No. 2120-0022 11/30/2007

TYPE OR PRINT ALL ENTRIES IN INK
U.S. Department of Transportation
Federal Aviation Administration

AIRMAN CERTIFICATE AND/OR RATING APPLICATION
MECHANIC

REPAIRMAN

PARACHUTE RIGGER

AIRFRAME

SENIOR

POWERPLANT
APPLICATION FOR:

(Specify Rating)

ORIGINAL ISSUANCE

'

ADDED RATING

CHEST

BACK

LAP

K. PERMANENT MAILING ADDRESS

A. NAME (First, Middle, Last)

I. APPLICANT INFORMATION

MASTER

SEAT

B. SOCIAL SECURITY NO.

C. DOB (Mo., Day., Yr.)

D. HEIGHT

E. WEIGHT

NUMBER AND STREET, P.O. BOX, ETC.

IN.
F. HAIR

G. EYES

H. SEX

I. NATIONALITY (Citizenship)
CITY

J. PLACE OF BIRTH
STATE
ZIP CODE
M. DO YOU NOW OR HAVE YOU EVER HELD AN FAA AIRMAN
CERTIFICATE?
NO
YES

L. HAVE YOU EVER HAD AN AIRMAN CERTIFICATE SUSPENDED OR REVOKED?
NO

SPECIFY TYPE:

YES (If "Yes," explain on an attached sheet keying to appropriate item number).
N. HAVE YOU EVER BEEN CONVICTED FOR VIOLATION OF ANY FEDERAL OR STATE STATUTES
PERTAINING TO NARCOTIC DRUGS, MARIJUANA, AND DEPRESSANT OR STIMULANT
DRUGS OR SUBSTANCES? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
B. MILITARY
EXPERIENCE

A. CIVIL
EXPERIENCE

II. CERTIFICATE OR
RATING APPLIED FOR
ON BASIS OF -

DATE OF FINAL CONVICTION
NO

YES
C. LETTER OF RECOMMENDATION FOR
REPAIRMAN (Attach copy)

(1) NAME AND LOCATION OF SCHOOL
D. GRADUATE
OF APPROVED
COURSE

(2) SCHOOL NO.

(3) CURRICULUM FROM WHICH GRADUATED

E. STUDENT HAS MADE SATISFACTORY PROGRESS
AND IS RECOMMENDED TO TAKE THE ORAL/
PRACTICAL TEST (FAR 65.80)

(1) SCHOOL NAME

(1) SERVICE

A. MILITARY
COMPETANCE
OBTAINED IN

NO.

(2) SCHOOL OFFICIAL'S SIGNATURE

(2) DATE AUTH. EXPIRES (3) FAA INSPECTOR SIGNATURE

(1) DATE AUTH.

F. SPECIAL AUTHORIZATION TO TAKE
MECHANIC'S ORAL/PRACTICAL TEST
(FAR 65.80)

(4) DATE

(2) RANK OR PAY LEVEL

(4) FAA DIST OFC.

(3) MILITARY SPECIALITY CODE

III. RECORD OF EXPERIENCE

B. APPLICANT'S OTHER THAN FAA CERTIFICATED SCHOOL GRADUATES. LIST EXPERIENCE RELATING TO CERTIFICATE AND RATING APPLIED FOR.
(Continue on separate sheet, if more space is needed).
DATES-MONTH AND YEAR
FROM

EMPLOYER AND LOCATION

TO

SEAT

CHEST

BACK

C. PARACHUTE RIGGER APPLICANTS:
INDICATE BY TYPE HOW MANY
PARACHUTES PACKED

TYPE WORK PERFORMED

LAP

FOR
MASTER
RATING
ONLY

PACKED AS A SENIOR
RIGGER

MILITARY
RIGGER

I CERTIFY THAT THE STATEMENTS BY ME ON THIS APPLICATION ARE TRUE

IV. APPLICANT'S
CERTIFICATION

A. SIGNATURE

I FIND THIS APPLICANT MEETS THE EXPER-

V.IENCE REQUIREMENTS OF FAR 65 AND IS

B. DATE

DATE

INSPECTOR'S SIGNATURE

FAA DISTRICT OFFICE

ELIGIBLE TO TAKE THE REQUIRED TESTS.

Emp.

.reg.

D.O.

.seal .con iss.

Act

.lev .TR .s.h. .Src

#rte

FOR FAA USE ONLY
Rating (1)

LIMITATIONS

FAA Form 8610-2 (2-85) SUPERSEDES PREVIOUS EDITION

Electronic Version (Adobe)

Rating (2)

Rating (3)

Rating (4)

Results of Oral and Practical Tests
MECHANIC

PARACHUTE RIGGER

I. GENERAL - Airframe and powerplant
PASS

PASS

EXPIRATION
DATE:

FAIL

TYPE

ORAL TEST

EXPIRATION
DATE:

QUES.
NO.
PRACTICAL TEST

FAIL

SEAT

PASS

FAIL

BACK

PASS

FAIL

CHEST

PASS

FAIL

LAP

PASS

FAIL

PASS

FAIL

PROJ.
NO.

REMARKS

II. AIRFRAME STRUCTURES
ORAL TEST

PASS

EXPIRATION
DATE:

FAIL

PASS

EXPIRATION
DATE:

FAIL

QUES.
NO.
PRACTICAL TEST
PROJ.
NO.
III. AIRFRAME SYSTEMS AND COMPONENTS
ORAL TEST

PASS

EXPIRATION
DATE:

FAIL

PASS

EXPIRATION
DATE:

FAIL

QUES.
NO.
PRACTICAL TEST
PROJ.
NO.
IV. POWERPLANT THEORY AND MAINTENANCE
ORAL TEST

PASS

EXPIRATION
DATE:

FAIL

PASS

EXPIRATION
DATE:

FAIL

QUES.
NO.
PRACTICAL TEST
PROJ.
NO.
V. POWERPLANT SYSTEMS AND COMPONENTS
ORAL TEST

PASS

EXPIRATION
DATE:

FAIL

PASS

EXPIRATION
DATE:

FAIL

QUES.
NO.
PRACTICAL TEST
PROJ.
NO.

DESIGNATED EXAMINER'S REPORT
I have personally tested this applicant in accordance with pertinent procedures and standards, and
I HAVE INDICATED

APPROVED (Temporary Certificate Issued)

APPROVED (Temporary Certificate NOT Issued)

THE RESULT AS:

DISAPPROVED

FAR 65.80 - ORAL/PRACTICAL PASSED

ATTACHMENTS:
DATE TEST COMPLETED

REPORT OF WRITTEN TEST

SUPERSEDED CERTIFICATE

LETTER

FAA FORM 8610-2

TEMPORARY CERTIFICATE

SEAL SYMBOL CARD

EXAMINER'S SIGNATURE

DESIGNATION NO.

APPLICANT'S CERTIFICATION
THIS BLOCK MUST BE COMPLETED BY THE APPLICANT AT THE TIME OF ISSUANCE OF TEMPORARY CERTIFICATE (FAA FORM 8060-4)

A. HAVE YOU EVER HAD AN AIRMAN CERTIFICATE SUSPENDED OR REVOKED? . . . . . . . . . . . . . . .
B. HAVE YOU EVER BEEN CONVICTED FOR VIOLATION OF ANY FEDERAL OR STATES STATUTES
PERTAINING TO NARCOTIC DRUGS, MARIJUANA, DEPRESSANT OR STIMULANT
DRUGS OR SUBSTANCES? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I CERTIFY THAT THE STATEMENTS BY ME ARE TRUE.

NO

Yes If "Yes," explain on an attached sheet.
DATE OF FINAL CONVICTION

NO

YES

B. DATE

A. SIGNATURE

FAA INSPECTOR'S REPORT
I HAVE

WITH THE INDICATED RESULT

EXAMINED THIS APPLICANT'S PAPERS.

APPROVED

PERSONALLY TESTED THIS APPLICANT IN
ACCORDANCE WITH PERTINENT PROCEDURES
AND STANDARDS.

DISAPPROVED
DATE

INSPECTOR'S SIGNATURE

Electronic Version (Adobe)

PARACHUTE SEAL
SYMBOL ASSIGNED
ANSWER SHEET GRADED
(Military Competency)
FAA DISTRICT OFFICE