DPE SUPPLEMENTAL INFORMATION
This sample document, or a similar format may be used to provide supplemental information to support eligibility, and qualifications for appointment as a FAA Designated Pilot Examiner (DPE).
Describe your experience that pertains to qualifications for a Designated Pilot Examiner (DPE). Please be detailed in your responses in order to support your experience. Refer to FAA Order 8000.95 Designee Management System, Volume 3 for minimum experience requirements for a DPE. You may attach additional experience pages as necessary.
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Name of Employer/Organization: |
Telephone Number: |
Street Address: |
City: |
State (Country if other than USA): |
Zip/Postal Code: |
Job/Position Title: |
Dates Employed: From: ________________ To:___________________ |
Supervisor’s Name: |
FAA Air Agency or Air Operator Certificate Number (If applicable): |
Experience (add additional pages if needed): |
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Name of Employer/Organization: |
Telephone Number: |
Street Address: |
City: |
State (Country if other than USA): |
Zip/Postal Code: |
Job/Position Title: |
Dates Employed: From: ________________ To:___________________ |
Supervisor’s Name: |
FAA Air Agency or Air Operator Certificate Number (If applicable): |
Experience (add additional pages if needed): |
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Name of Employer/Organization: |
Telephone Number: |
Street Address: |
City: |
State (Country if other than USA): |
Zip/Postal Code: |
Job/Position Title: |
Dates Employed: From: ________________ To:___________________ |
Supervisor’s Name: |
FAA Air Agency or Air Operator Certificate Number (If applicable): |
Experience (add additional pages if needed): |
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Name of Employer/Organization: |
Telephone Number: |
Street Address: |
City: |
State (Country if other than USA): |
Zip/Postal Code: |
Job/Position Title: |
Dates Employed: From: ________________ To:___________________ |
Supervisor’s Name: |
FAA Air Agency or Air Operator Certificate Number (If applicable): |
Experience (add additional pages if needed): |
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Name of Employer/Organization: |
Telephone Number: |
Street Address: |
City: |
State (Country if other than USA): |
Zip/Postal Code: |
Job/Position Title: |
Dates Employed: From: ________________ To:___________________ |
Supervisor’s Name: |
FAA Air Agency or Air Operator Certificate Number (If applicable): |
Experience (add additional pages if needed): |
FAA Certificates Held
Provide the details of any FAA certificates held.
CERTIFICATE TYPE |
CERTIFICATE NUMBER |
RATINGS |
DATE OF ISSUANCE |
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Flight Experience
Aircraft Category/Class |
Total Pilot-in-Command |
Pilot-in-Command in the Past 12 Months |
Total Flight Instruction Given |
Instrument Flight Instruction Given |
Flight Instruction Given in the Past 12 Months (In Balloons) |
Night Pilot-in-Command |
Instrument Pilot-in-Command |
Airplane Single-Engine Land |
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Airplane Multiengine Land |
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Airplane Single-Engine Sea |
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Airplane Multiengine Sea |
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Helicopter |
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Gyroplane |
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Glider |
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Balloon |
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Airship |
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Large and Turbine Powered Aircraft Flight Experience
Enter turbine powered, large airplanes, and/or large helicopters.
Aircraft Make and Model |
Pilot-in-Command Total |
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | Applicant’s Name__________________________________________________ |
Author | DOT/FAA |
File Modified | 0000-00-00 |
File Created | 2024-10-29 |