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

OMB CONTROL NUMBER: 2120-0007
EXPIRATION DATE: 9/30/2018

U.S. Department of
Transportation
Federal Aviation
Administration

INFORMATION FOR APPLICANT

Application for an Airman Certificate and/or Rating
Paperwork Reduction Act Statement:
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor
shall a person be subject to a penalty for failure to comply with a collection of information
subject to the requirements of the Paperwork Reduction Act unless that collection of
information displays a currently valid OMB Control Number. The OMB Control Number for this
information collection is 2120-0007. Public reporting for this collection of information is
estimated to be approximately 15 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed,
completing and reviewing the collection of information.
All responses to this collection of information are mandatory per 14 CFR Part 63. Send
comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to: Information Collection Clearance Officer,
Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth, TX 76177-1524

See Privacy Act Information Below.

Tear off this cover sheet before submitting this form.

FAA Form 8400-3 (6-18) Supersedes Previous Edition

Electronic Version (Adobe)

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OMB CONTROL NUMBER: 2120-0007
EXPIRATION DATE: 9/30/2018
Application for an Airman Certificate and/or Rating
PRIVACY ACT STATEMENT: This statement is provided pursuant to the Privacy Act of 1974, 5 USC § 552a:
The authority for collecting this information is contained in 49 U.S.C. §§ 40113, 44702, 44703, 44709 and 14 C.F.R. Part 6 3. The
principal purpose for which the information is intended to be used is to identify and evaluate your qualifications and eligibility for the
issuance of an airman certificate and/or rating. Submission of the data is mandatory, except for the Social Security Number, which is
voluntary. Failure to provide all required information will result in our being unable to issue you a certificate and/or rating. The
information collected on this form will be included in a Privacy Act System of Records known as DOT/FAA 847, titled “Aviation Records
on Individuals” and will be subject to the routine uses published in the System of Records Notice (SORN) for DOT/FAA 847 (see
https://www.transportation.gov/individuals/privacy/privacy-act-system-records-notices), including:
(a) Providing basic airmen certification and qualification information to the public upon request; examples of basic information include:
• The type of certificates and ratings held, limitations, date of issuance and certificate number;
• The status of the airman’s certificate (i.e., whether it is current or has been amended, modified, suspended or revoked for any
reason);
• The airman’s home address, unless requested by the airman to be withheld from public disclosure per 49 U.S.C. 44703(c);
• Information relating to an airman’s physical status or condition used to determine statistically the validity of FAA medical standards;
and the date, class, and restrictions of the latest physical
• Information relating to an individual’s eligibility for medical certification, requests for exemption from medical requirements, and
requests for review of certificate denials. (b) Using contact information to inform airmen of meetings and seminars conducted by
the FAA regarding aviation safety.
(c) Disclosing information to the National Transportation Safety Board (NTSB) in connection with its investigation responsibilities.
(d) Providing information about airmen to Federal, State, local and tribal law enforcement agencies when engaged in an official
investigation in which an airman is involved. (e) Providing information about enforcement actions, or orders issued thereunder, to
Federal agencies, the aviation industry, and the public upon request.
(f) Making records of delinquent civil penalties owed to the FAA available to the U.S. Department of the Treasury and the U.S.
Department of Justice (DOJ) for collection pursuant to 31 U.S.C. 3711(g).
(g) Making records of effective orders against the certificates of airmen available to their employers if the airmen use the affected
certificates to perform job responsibilities for those employers.
(h) Making airmen records available to users of FAA’s Safety Performance Analysis System (SPAS), including the Department of
Defense Commercial Airlift Division’s Air Carrier Analysis Support System (ACAS) for its use in identifying safety hazards and risk
areas, targeting inspection efforts for certificate holders of greatest risk, and monitoring the effectiveness of targeted oversight actions.
(i) Making records of an individual’s positive drug test result, alcohol test result of 0.04 or greater breath alcohol concentration, or
refusal to submit to testing required under a DOT-required testing program, available to third parties, including current and prospective
employers of such individuals. Such records also contain the names and titles of individuals who, in their commercial capacity,
administer the drug and alcohol testing programs of aviation entities.
(j) Providing information about airmen through the Civil Aviation Registry’s Comprehensive Airmen Information System to the
Department of Health and Human Services, Office of Child Support Enforcement, and the Federal Parent Locator Service that locates
noncustodial parents who owe child support. Records in this system are used to identify airmen to the child support agencies
nationwide in enforcing child support obligations, establishing paternity, establishing and modifying support orders and location of
obligors. Records listed within the section on Categories of Records are retrieved using Connect: Direct through the Social Security
Administration’s secure environment.
(k) Making personally identifiable information about airmen available to other Federal agencies for the purpose of verifying the accuracy
and completeness of medical information provided to FAA in connection with applications for airmen medical certification.
(l) Making records of past airman medical certification history data available to Aviation Medical Examiners (AMEs) on a routine basis
so that AMEs may render the best medical certification decision.
(m) Making airman, aircraft and operator record elements available to users of FAA’s Skywatch system, including the Department of
Defense (DoD), the Department of Homeland Security (DHS), DOJ and other authorized Federal agencies, for their use in managing,
tracking and reporting aviation-related security events.
(n) Other possible routine uses published in the Federal Register (see Prefatory Statement of General Routine Uses for additional uses
(65 F.R. 19477-78) For example, a record from this system of records may be disclosed to the United States Coast Guard (Coast
Guard) and to the Transportation Security Administration (TSA) if information from this system was shared with either agency when that
agency was a component of the Department of Transportation (DOT) before its transfer to DHS and such disclosure is necessary to
accomplish a DOT, TSA or Coast Guard function related to this system of records.
FAA Form 8400-3 (6-18) Supersedes Previous Edition

Electronic Version (Adobe)

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Your signature on this form (FAA Form 8400-3) acknowledges that you received the Pilot’s Bill of Rights Written
Notification of Investigation at the time of this application.

PILOT’S BILL OF RIGHTS WRITTEN NOTIFICATION OF INVESTIGATION
The information you submit on the attached FAA Form 8400-3, Application for an Airman Certificate and/or Rating, will be
used by the Administrator of the Federal Aviation Administration as part of the basis for issuing an airman certificate,
rating, or inspection authorization to you under Title 49, United States Code (U.S.C.) section 44703(a), if the Administrator
finds, after investigation, that you are qualified for, and physically able to perform the duties related to the certificate,
rating, or inspection authorization for which you are applying. Therefore, in accordance with the Pilot’s Bill of Rights, the
Administrator is providing you with this written notification of investigation of your qualifications for an airman certificate,
rating, or inspection authorization:
•The nature of the Administrator’s investigation, which is precipitated by your submission of this application, is to
determine whether you meet the qualifications for the airman certificate, rating or inspection authorization you are
applying for under Title 14, Code of Federal Regulations (CFR) part 63 or part 65.
•Any response to an inquiry by a representative of the Administrator by you in connection with this investigation of your
qualifications for an airman certificate, rating, or inspection authorization may be used as evidence against you.
•A copy of your airman application file for this date is available to you upon your written request addressed to: Federal
Aviation Administration Airmen Certification Branch P.O. Box 25082 Oklahoma City, OK 73125-0082 (If you make a
written request for your airman application file, please provide your full name, date of birth or airman certification
number for identification purposes, and the date of application.)

FAA Form 8400-3 (6-18) Supersedes Previous Edition

Electronic Version (Adobe)

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Form Approved
OMB NO. 2120-0007
09/30/2018

Application for an Airman Certificate and/or Rating

U.S. Department of Transportation
Federal Aviation Administration

A.

Flight Engineer

B.

Flight Navigator

D.

Aircraft Dispatcher

C.

Control Tower Operator

E.

Reissuance of Certificate

F.

Additional Rating

A1.

Reciprocating Engine Powered

A2.

Turbo Propeller Powered

C1.

VFR Tower Rating

A3.

Turbojet Powered

C2.

Non-Radar Approach Control Tower Rating

1.TYPE OF AIRCRAFT TO BE USED

2.TIME IN THIS AIRCRAFT

3. NAME OF EMPLOYER

4.APPLICANT IDENTIFICATION
A. Name (First, Middle, Last)

K. Permanent Mailing Address (include zip code)

B. Social Security Number

C. Date Of Birth

F. Hair

H. Sex

G. Eyes

D. Height

E. Weight

I. Nationality
L. Telephone Number.

J. Place Of Birth
5. CERTIFICATES HELD BY APPLICANT
A.
Pilot
A1.

Airline Transport

A3.

A2.

Commercial

A4.

B.

Flight Navigator

E.

Ground Instructor

Flight Instructor

C.

Control Tower Operator

F.

Aircraft Dispatcher

Private

D.

Flight Engineer

G.

Mechanic

6. Controlled Substance Violation History: Have you ever been convicted for violation of any Federal or State statutes relating to
narcotic drugs, marijuana, or depressant or stimulant drugs or substances? Do not include alcohol offenses involving motor vehicle mode of
transportation as those offenses are covered on the FAA Form 8500-8, Airman Medical Application Form
Yes
No

Date of Final
Conviction

7. APPLICANT’S CERTIFICATION: I certify that all statements and answers provided by me on this application form are complete and true to the best of my
knowledge and I agree that they are to be considered as part of the basisfor issuance of any FAA certificate to me. I have received the Pilot’s Bill of Rights
Written Notification of Investigation that accompanies this form. I have also read and understand the Privacy Act statement that accompanies this form.

Signature of Applicant

Date (mm/dd/yyyy)

8. INSTRUCTOR’S RECOMMENDATION: I consider the above applicant ready to take
the test for which he/she is applying:

A.

Oral Test

B.

Flight

C.

Practical Test

D.Date

D1.Instructor’s Signature

D2.Instructor’s Certificate No. & Expiration Date

D3.Grade & Certificate No.

E.Date

E1.Instructor’s Signature

E2.Instructor’s Certificate No. & Expiration Date

E3.Grade & Certificate No.

9.EVALUATION RECORD
Inspector

Examiner

Signature

Date

A.Oral
B. Practical Test
Aircraft Dispatcher
C. Practical Test
Control Tower Operator
D. Simulator Check
E. Aircraft Flight Check
10.INSPECTOR’S RECORD
A.

Temporary Airman Certificate Issued

D. Date

CP

REQ

B.

Notice of Disapproval of Application Issued

E. Inspector’s signature

OFFICE

COM

ISS

ACT

EMP

TRN

C.

Examiner’s Action Accepted

F. FAA office

M.T.

DIS

CLASS

SEX

RATING

STATE

COUNTY

Aircraft Dispatcher

IFO Mailing

Special Mailing

Correspondence

Airmail

FAA Form 8400-3 (6-18) Supersedes Previous Edition

Electronic Version (Adobe)

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Form Approved
OMB NO. 2120-0007
09/30/2018

11. PRACTICAL TEST REPORT

8
9

Forms and Records
Post Flight

10
11

Crew Coordination
Judgment

D. Control Tower Operator

VFR TOWER RATING

Equipment (Oral)
Equipment Check
Preflight Training

4
5

1

11. Route of Flight Check
From

The Control Tower
The Airport
The Control Zone
Notice to Airmen

1
2
3

Weather Facilities and Procedures
A Demonstration of Ability to Control
Air Traffic Under VFR

6

Normal Navigation Procedures
Knowledge of Navigation Methods
Coordination of Navigational Methods
Emergency Procedures
Coordination of Duties
Crew Coordination
Judgment

9
10

Inspector

Examiner

Item No.

B. Flight Navigator

3
4
5
6
7
8

To

Inspector

Grade

Grade

1
2

Examiner

Abnormal Emergency Procedures
English Language Proficiency

Hours
Day

Night

NON-RADAR APPROACH CONTROL TOWER RATING
Air Traffic Control Facilities

2
3
4
5
6

Air Navigation Facilities

7
8

Alternate Airports
Search and Rescue Procedures
A Demonstration of Ability to Control
Air Traffic Under IFR

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

9

10

Airman’s Identification (ID)

Form of ID

Number

Inspector

Emergency Procedures

Examiner

7

Flight Planning/ Dispatch/Release
Preflight Takeoff, Departure
In-flight Procedures
Arrival, Approach, Landing
Post Flight

Item No.

Normal Operating Procedures
Abnormal Operating Procedures
Performance Data and Cruise Control
Trouble Shooting

C. Aircraft Dispatcher

1
2
3
4
5
6
7

Equipment Examination (Oral)
Preflight Inspection

1
2
3
4
5
6

Item No.

A. Flight Engineer

Grade
Inspector

Examiner

Item No.

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

Airport Identification

12. Aviation English Language Standard
A.

Meets Aviation English Language Standard.

B.

Does Not Meet Aviation English Language Standards

C.

Referred to FSO for Aviation English Language Standard
Determination.

Remarks:

Expiration Date

FAA Form 8400-3 (6-18) Supersedes Previous Edition

Electronic Version (Adobe)

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13. REMARKS

FAA Form 8400-3 (6-18) Supersedes Previous Edition

Electronic Version (Adobe)

Form Approved
OMB NO. 2120-0007
09/30/2018

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