Form DD Form 2627 DD Form 2627 Request for Government Approval for Aircrew Qualificatio

OMB No. 0704-0347
OMB approval expires

REQUEST FOR GOVERNMENT APPROVAL FOR
AIRCREW QUALIFICATIONS AND TRAINING

The public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 1155 Defense
Pentagon, Washington, DC 20301-1155 (0704-0347). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with
a collection of information if it does not display a currently valid OMB control number.

PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. RETURN COMPLETED FORM TO THE GOVERNMENT FLIGHT REPRESENTATIVE.

PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. 133, Under Secretary of Defense for Acquisition and Technology; 10 U.S.C. 3013,
Secretary of the Army; 10 U.S.C. 5013, Secretary of the Navy; 10 U.S.C. 8013, Secretary of the Air Force; and E.O. 9397 (SSN).
PRINCIPAL PURPOSE(S): Used to monitor and manage individual contract flight/ground crew records.
ROUTINE USE(S): Data may be provided to the Federal Aviation Agency or other aviation authorities to carry out official functions. Data may also be
provided under any of the blanket routine uses published by the Defense Components.
DISCLOSURE: Voluntary; however, failure to provide the information could result in disapproval of your request to participate in the program.
1. FROM (Name and Address of Contractor's Requesting Official)

2. TO (Name and Address of Government Flight Representative)

3. CREWMEMBER NAME (Last, First, Middle Initial)

4. SSN

5. DATE OF BIRTH (YYYYMMDD)

6. AIRCRAFT

8. SECURITY CLEARANCE

9. FAA RATING

7. CREW POSITION

10. EDUCATIONAL BACKGROUND
a. HIGH SCHOOL (1) NAME

(2) LOCATION (Include Zip Code)

(3) DATE COMPLETED (YYYYMM)

b. COLLEGE(S) OR UNIVERSITY(IES) (1) NAME

(2) LOCATION (Include Zip Code)

(3) DEGREE(S) OBTAINED

c. FLIGHT SCHOOL (1) NAME

(2) DATE COMPLETED
(YYYYMMDD)

d. TEST PILOT SCHOOL (1) NAME

(2) DATE COMPLETED
(YYYYMMDD)

D R A F T

e. SPECIAL PROFESSIONAL SCHOOL(S) (List name of school, location, primary subject of study, and date completed) (Use additional sheets if necessary)

11. HAVE YOU EVER SERVED IN ANY BRANCH OF THE U.S. MILITARY SERVICE? (X one)
a. BRANCH OF SERVICE

b. SERVICE DATES (YYYYMMDD)
(1) FROM

d. HIGHEST RANK

e. AERONAUTICAL RATING

YES (Complete a. - f.)

NO

c. LAST LOCATION

(2) TO
f. ARE YOU NOW A MEMBER OF THE RESERVES OR NATIONAL GUARD? (X one)
YES (If Yes, specify:)

(1) BRANCH OF SERVICE

(2) PRESENT RANK

NO

12. PROVIDE A RESUME OF EXPERIENCE IN THE FLIGHT TEST FIELD.
RESUME ATTACHED. (X if applicable)

(Include both engineering and aircrew experience by project, type of
aircraft, and hours flown.)

13. FLIGHT CREWMEMBER CERTIFICATION. I certify that I have read and understand all of the contractor's procedures and directives
pertinent to the accomplishment of my assigned duty.
a. TYPED NAME (Last, First, Middle Initial)

b. SIGNATURE

c. DATE SIGNED

14. CONTRACTOR'S REQUESTING OFFICIAL (CRO)
I have verified the records of the crewmember above and request that he/she be approved for qualification training as a (crew position)
for (Strike out all inapplicable) experimental/engineering/acceptance/
production/functional/support flights in
a. TYPED NAME (Last, First, Middle Initial)

type aircraft.
b. SIGNATURE

c. DATE SIGNED

15. GOVERNMENT FLIGHT REPRESENTATIVE (GFR)
APPROVED

a. TYPED NAME (Last, First, Middle Initial)

b. SIGNATURE

c. DATE SIGNED

DISAPPROVED

DD FORM 2627, 20070428 DRAFT

PREVIOUS EDITION IS OBSOLETE.

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