General Aviation DPE, SAE, and Admin-PE Applicants

SAE 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 Specialty Aircraft Examiner (SAE), with Vintage Aircraft Examiner (VAE), Experimental Aircraft Examiner (EAE), Limited Aircraft Examiner (LAE) or Vintage Flight Engineer Examiner (VFEE) authorizations.

Describe your experience that pertains to qualifications for a Specialty Aircraft Examiner (SAE). 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 SAE. You may attach additional experience pages as necessary.

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):

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):

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):

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):

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

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
Airplane Multiengine Land
Airplane Single-Engine Sea
Airplane Multiengine Sea
Helicopter
Gyroplane
Glider
Balloon
Airship

Large and Turbine Powered Aircraft Flight Experience

Enter turbine powered, large airplanes, and/or large helicopters.

Aircraft Make and Model	Pilot-in-Command Total