Form 8710-4 Rotorcraft External-Load Operator Certificate Applicatio

OMB CONTROL NUMBER: 2120-0044
EXPIRATION DATE: May 31, 2018

US Department
of Transportation
Federal Aviation
Administration

ROTORCRAFT EXTERNAL-LOAD OPERATOR CERTIFICATE APPLICATION
Paperwork Reduction Act Burden 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 2120-0044. Public reporting for this
collection of information is estimated to be approximately 18 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 required to obtain or retain a benefit (14 CFR 133.15); no confidentiality
is provided. 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

SUPPLEMENTAL
INFORMATION
Form 8710-4 (11/2007)

Form Approved: OMB No. 2120-0044
11/30/2011
US Department
of Transportation

Rotorcraft External-Load Operator Certificate Application

Federal Aviation
Administration

INSTRUCTIONS: Submit this form in triplicate to local FAA District Office
1. APPLICATION FOR (CHECK APPLICABLE BOX)

CERTIFICATE NO. (For amendment
or renewal only.)

ORIGINAL ISSUANCE

EXTERNAL - LOAD CLASS
AUTHORIZATION (S)

AMENDMENT

A

RENEWAL
2. NAME AND ADDRESS OF APPLICANT (Include Zip Code)

C

D

3. PRINCIPAL OR LOCAL BASE OF OPERATIONS (Airport, City,
State, and Zip Code)

TELEPHONE NUMBER
TELEPHONE NUMBER
4. NAME OF CHIEF PILOT OR PILOT IN CHARGE OF LOCAL OPERATION

AIRMAN
CERTIFICATE

5.

B

GRADE

NUMBER

ROTORCRAFT TO BE USED
REGISTRATION
NUMBER

TYPE
MAKE

LOAD CLASS (X)
MODEL

A

B

C

D

ATTACH
PREV

DEVICE
APPD.

YES

NO

REMARKS

CERTIFICATION

I certify that the statements made on this application form and any attachments are true and correct, and that the operations
indicated on this application will be conducted within the requirements of the Federal Aviation Act of 1958 and the applicable Federal
Aviation Regulations.
DATE

FAA Form 8710-4

TITLE OF AUTHORIZED OFFICER

(11-2007) SUPERSEDES FAA FORM 8420-7 and FAA FORM 8000-32

SIGNATURE OF APPLICANT OR AUTHORIZED OFFICER

Electronic Version (Adobe)

INSPECTION REPORT
(To be completed by FAA District Office Representative)
ROTORCRAFT
MAKE

MODEL

REGISTRATION
NUMBER

APPROVAL
DATE

CLASS

LIMITATIONS
AND
REMARKS

WEIGHT
AUTHORIZED

INSPECTOR'S
SIGNATURE

REMARKS

CHIEF PILOT KNOWLEDGE AND SKILL REQUIREMENTS MET BY:
NAME OF CHIEF PILOT

DATE

Applicant is Fully Qualified to Conduct External - Load Operations in Class (es)

CERTIFICATE NUMBER

Class A

Class B

APPLICATION DISAPPROVED

FAA DISTRICT OFFICE

Class C

SIGNATURE OF INSPECTOR

Class D

REASONS:

SIGNATURE OF SUPERVISING INSPECTOR

Electronic Version (Adobe)

ISSUED ON