DD Form 2628 Request for Contractor Flight Crewmember

REQUEST FOR APPROVAL OF CONTRACTOR FLIGHT CREWMEMBER

OMB No. 0704-0347
OMB Approval Expires:
20230930

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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, at [email protected]. Respondents
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OMB control number.

1. FROM (Name and Address of Contractor's Requesting Official)

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

3. CONTRACTOR'S REQUESTING OFFICIAL (CRO).
I have verified the records of (Crewmember's name)
as a (crew position)
experimental

engineering

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

and request that he/she be approved
for (Check all applicable)

functional check

maintenance test

support

flights in

b. SIGNATURE

type aircraft.
c. DATE SIGNED

4. INSTRUCTOR PILOT/FLIGHT EXAMINER (IP/FE)
I certify that the crewmember above has satisfactorily flown a proficiency flight check on (Date)
a. TYPED NAME (Last, First, Middle Initial)

b. SIGNATURE

.
c. DATE SIGNED

5. GOVERNMENT FLIGHT REPRESENTATIVE (GFR)
APPROVED

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

b. SIGNATURE

DISAPPROVED

DD FORM 2628, SEP 2020

PREVIOUS EDITION IS OBSOLETE.

c. DATE SIGNED