Form DD Form 1821 DD Form 1821 Contractor Crew Member Summary

Clear Form

Controlled Unclassified Information (CUI)(When Filled In)

OMB No.
0704-0347
Expires: September 30,
2026

CONTRACTOR CREWMEMBER FLIGHT SUMMARY
Privacy Act Statement
AUTHORITY: 27 U.S.C. 310a, Public Law 92-204; Public Law 93-294; DODD 7730.57

PURPOSE AND USE: This form is intended to serve as a summary of an individual’s flight record to support the contractor crewmember
approval process.
ROUTINE USE: May be disclosed for any of the blanket routine uses published by the DoD. DISCLOSURE IS VOLUNTARY: However, failure
to provide information may prevent authorization to perform duties in aircraft under Government contract.

1. NAME OF CREWMEMBER (Last Name, First, Middle Initial):
3. MISSION, DESIGN, AND SERIES (MDS)
AIRCRAFT OR OTHER REQUIREMENT FOR THIS
QUALIFICATION:

2. CONTRACTOR REPRESENTED (Name and address)

4a. IDENTIFY CREW POSITION AND QUAL:
4b. MISSION TYPE:

EXPERIMENTAL

ENGINEERING

FUNCTIONAL CHECK

MAINTENANCE TEST

SUPPORT

5. REASON FOR SUBMISSION:
INITIAL QUAL

REQUAL

QUALIFIED
NEW HIRE

UPGRADE TRNG

OTHER:

SECTION I – FLIGHT EXPERIENCE (Time to nearest hour)
6. FLYING TIME BY TYPE
JET

HRS

8.
AIRCRAFT
MDS
(Date Last
Flown)

7. TOTAL
FLYING TIME

TURBO PROP
PERIOD OF
TIME

9.
PILOT-INCOMMAND

HRS

UNMANNED

10.
COPILOT

11.
INSTRUCTOR
/
EVALUATOR

HRS
12.
NIGHT

ROTARY/TILTROTOR
13.
IMC

14.
SIM

HRS
15.
EXP
TEST

16.
ENG
TEST

17.
OTHER

Last 12 months
Total
Last 12 months
Total
Last 12 months
Total
Last 12 months
Total
Last 12 months
Total
Last 12 months
Total
Last 12 months
Total

Controlled By:
Controlled By:
CUI Categories: PROPIN/PRVCY Distribution/
Dissemination Control: FEDCON
POC:

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SECTION II ADDITIONAL REQUIREMENTS (Fill in where applicable)
REQUIREMENTS

CHECKED BY

DATE

PLACE

18. PHYSICAL EXAM
19. PHYSIOLOGICAL TRNG
20. CENTRIFUGE TRNG
21. ACFT EGRESS/EVAC TRNG
22. AFE/ALSE/ALSS TRNG
23. CRM/ACT TRNG
24. LAND SURVIVAL TRNG
25. WATER SURVIVAL TRNG
26. OTHER:
27. HAVE YOU EVER HAD AN AIRCRAFT ACCIDENT (as defined by FAR or military procedures) OR PHYSIOLOGICAL
REACTION (e.g. hypoxia, decompression sickness, spatial disorientation) AS A PILOT, OR OTHER CREW MEMBER? (If yes, explain.)

28. HAVE YOU EVER BEEN CHARGED WITH A FLYING VIOLATION? (If so, state the violation and circumstances.)

29. LIST ALL FAA CERTIFICATIONS, LICENSES, RATINGS, QUALIFICATIONS, ETC. (For additional space use blank sheet.)

30. I certify that all information listed on this form is accurate and I can provide source documentation if
requested.
Date

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Signature of Crewmember

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Contractor Crewmember Flight Summary Instructions

1. Name of Crewmember – self-explanatory
2. Contractor Represented – self-explanatory
3. MDS Aircraft, Crewmember Qual, and/or Other Requirements for this Qualification – selfexplanatory
4a. Identify Crew Position – MDS Crew position (Pilot, Co-Pilot, Crew Chief, WSO, etc.)
4b. Mission Type - Mission qualification level sought; should match DD2627 and DD2628
5. Select the reason for the crewmember record review
Section I. Complete all times by rounding to the nearest hour:
6. Flying Time by Type – self-explanatory
7. Total Flying Time – self-explanatory
8. MDS and Date Last Flown – Input applicable MDS. Like series aircraft may be grouped. Insert
date last flown below aircraft MDS. Use a separate sheet for additional aircraft.
9. Pilot-in-Command – for the purposes of this summary record, document the time as the
designated aircraft commander (not necessarily at the controls)
10. Copilot – document time in which crewmember records flight time but is not the aircraft
commander
11. Instructor/Evaluator – input combined instructor and evaluator hours as applicable
12. Night – self-explanatory
13. IMC – actual and/or simulated
14. Sim – self-explanatory
15. Experimental Test – input hours for experimental test as defined in the 8210-1 and acting as the
aircraft commander
16. Engineering Test – input hours for engineering test as defined in the 8210-1 and acting as the
aircraft commander
17. Other – for pilots: input time when not occupying a designated duty station or conforming to the
requirements of PIC or Copilot time. All other crewmembers (e.g., navigators, loadmasters, sensor
operators) may log flight time here.
Section II. Additional Requirements:
18. – 26. Additional Requirements – input the date & location of most recent training/event and
whom validated completion
27. – 28. Aircraft accident or physiological reaction & flying violation – self-explanatory
29. List FAA Qualifications – include all FAA qualifications, licenses, ratings, and certifications held
30. Read statement and sign to certify compliance and accuracy of records

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