Form 8400-3 Application for an Airman Certificate and/or Rating

U.S. Department

of Transportation

Federal Aviation

Administration

INFORMATION FOR APPLICANT

Application For An Airman Certificate and/or Rating
Privacy Act Statement
Information requested on this form is solicited under the authority of Title 49 of the United
StatesCode(Transportation)sections109(9), 40113(a), 44701-44703, and 44709 (1994),
formerly codified in the Federal Aviation Act of 1958, as amended, and Title 14 of the Code of
Federal Regulations (CFR), Part 67, Medical Standards and Certification. Submission of this
information is mandatory and incomplete submission will result in delay of consideration or
denial of application for an airman medical certificate.
The purpose of this information is to determine whether an applicant meets Federal Aviation
Administration medical requirements to hold an airman medical certificate for further
consideration under 14 CFR 11.53 and 67.401. It is also used to depict airman population
patterns and to update certification procedures and medical standards. The information
collected on this form becomes a part of the Privacy Act System of Records DOT/FAA 847,
General Air Transportation Records on Individuals, and is provided the protection outlined in
the system's description as published in the Federal Register.

Paperwork Reduction Act Statement:
The information collected on this form is necessary to determine applicant eligibility for flight
engineer or flight navigator certificates. The information is used to determine certification
eligibility. We estimated that it will take 6 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, General Air Transportation Records on
Individuals. 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 collection is 2120-0007.
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

Tear off this cover sheet before submitting this form.

FAA Form 8400-3 (1-98) Supersedes Previous Edition

Electronic Version (Adobe)

NSN: 0052-00-692-3002

Form Approved
OMB NO. 2120-0007
01/31/2008

U.S. Department of Transportation
Federal Aviation Administration

Application For An Airman Certificate and/or Rating

Flight Engineer
Reciprocating Engine Powered

Flight Navigator

Aircraft Dispatcher

Control Tower Operator

Reissuance of Certificate

Turbopropeller Powered

VFR Tower Rating

Turbojet

Powered

Non-Radar Approach Control
Tower Rating

Additional Rating

3. NAME OF EMPLOYER

2. TIME IN THIS AIRCRAFT

1. TYPE OF AIRCRAFT TO BE USED
4. Applicant Identification
A. NAME (First, Middle, Last)

K. PERMANENT MAILING ADDRESS
(Include Zip Code)

C. DATE OF BIRTH

B. SOCIAL SECURITY NO.

H. SEX

G. EYES

F. HAIR

D. HEIGHT

E. WEIGHT

I. NATIONALITY
TELEPHONE NO.

J. PLACE OF BIRTH
5. Certificates Held by Applicant
A.

Pilot

B. Flight Navigator

E. Ground Inspector

Airline Transport

Flight Instructor

C. Control Tower Operator

F. Aircraft Dispatcher

Commercial

Private

D. Flight Engineer

G. Mechanic

6. Applicant's Certification I certify that I meet all pertinent
requirements of the Regulations for the certificate or
rating applied for
Instructor's Recommendation
7. I consider the above applicant ready to take
the test for which he/she is applying:

Date

A. Oral Test

Applicant's Signature

C. Practical Test
Aircraft Dispatcher

or

B. Flight

D. Date

Instructor's Signature

Instructor's Certificate No. & Expiration Grade & Certificate No.
Date

E. Date

Instructor's Signature

Instructor's Certificate No. & Expiration Grade & Certificate No.
Date

8. Evaluation Record
Inspector

Oral

Examiner

Signature

Date

Practical Test
Aircraft Dispatcher
Practical Test
Control Tower Operator
Simulator Check
Aircraft Flight Check
9. Inspector's Record
Temporary Airman Certificate
Issued

INSPECTOR'S SIGNATURE

DATE
CP

Notice of Disapproval of Application Issued

REQ.

OFFICE

COM ISS

ACT

EMP

TRN M.T. DIS

Examiner's Action Accepted

FAA OFFICE
CLASS

SEX

RATING

STATE

COUNTY

Aircraft Dispatcher

IFO Mailing

Special Mailing

Correspondence

Airmail
FAA Form 8400-3 (1-98) Supersedes Previous Edition

Electronic Version (Adobe)

NSN: 0052-00-692-3002

Form Approved
OMB NO. 2120-0007
01/31/2008

10. Practical Test Report
Grading Legend (All applicable items must be graded S or U)
Explain in ''Remarks'' all items which are not graded.
S-Satisfactory, U-Unsatisfactory

Equipment Examination (Oral)
Preflight Inspection

1
2
3
4
5
6
7

Normal Operating Procedures
Abnormal Operating Procedures
Performance Data and Cruise Control
Trouble Shooting
Emergency Procedures
Forms and Records
Post Flight
Crew Coordination
Judgement

Dispatch and Assistance
Emergency Procedures
Grade
D. Control Tower Operator

VFR TOWER RATING

B. Flight Navigator

Inspector

Examiner

Item No.

Grade

Equipment (Oral)
Equipment Check
Preflight Training

1
2
3
4
5
6
7
8

11. Route of Flight Check
From

1
2
3
4
5
6

Normal Navigation Procedures
Knowledge of Navigation Methods
Co-ordination of Navigational Methods
Emergency Procedures
Co-ordination of Duties
Crew Coordination
Judgement

9
10

To

Examiner

Aircraft
Air Routes and Airports
Altimeters
Weather Analysis
Airman's Information Manual

Hours
Day

Night

The Control Tower
The Airport
The Control Zone
Notice to Airmen
Weather Facilities and Procedures
A Demonstration of Ability to Control
Air Traffic Under VFR

1

NON-RADAR APPROACH CONTROL TOWER RATING
Air Traffic Control Facilities

2

Air Navigation Facilities

3
4
5
6
7
8

Use of Airman's Information Manual
Holding Procedures
Approach Procedures
Missed Approach Facilities
Alternate Airports

9
10

Search and Rescue Procedures
A Demonstration of Ability to Control
Air Traffic Under IFR
Airport Identification

Airmans Identification (ID)

Form of ID
Number
Expiration Date

10. Remarks

FAA Form 8400-3 (1-98) Supersedes Previous Edition

Electronic Version (Adobe)

NSN: 0052-00-692-3002

Inspector

9
10
11

Item No.

7
8

C. Aircraft Dispatcher

Examiner

1
2
3
4
5
6

Item No.

Inspector

Examiner

Item No.

A. Flight Engineer

Inspector

Grade

Grade