DART Supplemental Information Sheet

DART-T 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 Airworthiness Representative – Maintenance (DAR-T).

FAA Certificates Held

Provide the details of any FAA certificates held that are relevant to application for a DAR-T. For repairman certificates, also include the limitations stated on the certificate in the “RATINGS” column.

CERTIFICATE TYPE	CERTIFICATE NUMBER	RATINGS	DATE OF ISSUANCE

Relevant Work Experience

Describe your experience that pertains to qualifications for a DAR-T. Please be detailed in your responses in order to support your experience for different DAR-T function codes. You may attach additional experience pages as necessary. A sample blank page is included for your use. Refer to FAA Order 8000.95 Designee Management System, Volume 5 for minimum experience requirements.

Standard Airworthiness Certification, Function Codes 101-125

Describe any experience you have working in a position of responsibility for approval for return to service or determining eligibility for issuance of a standard airworthiness certificate or Special Airworthiness Certificate in the primary, restricted, or limited categories of aircraft. Include the types of aircraft on which you gained the experience and where the experience was obtained. Refer to FAA Order 8000.95 Designee Management System, Volume 5 for qualification requirements.

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):

Experimental Category Certification, Function Codes 128-140

Describe any experience in the maintenance, inspection, alteration or certification of aircraft holding a Special Airworthiness Certificate for the purposes of market survey, research and development, crew training, exhibition, or air racing. Include the types of aircraft on which you gained the experience and where the experience was obtained. Refer to FAA Order 8000.95 Designee Management System, Volume 5 for qualification requirements.

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):

Amateur-Built or Light Sport Aircraft, Function Codes 147-162

Describe any experience in the maintenance, inspection, alteration or certification of Amateur-Built or Light Sport aircraft. Include the types of aircraft on which you gained the experience and where the experience was obtained. Refer to FAA Order 8000.95 Designee Management System, Volume 5 for qualification requirements.

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):

Aircraft Export Airworthiness Approvals, Function Codes 177-176,

Describe any experience in demonstrating eligibility for export approval of aircraft, or issuing aircraft export approvals. Include the types of aircraft on which you gained the experience and where the experience was obtained. Refer to FAA Order 8000.95 Designee Management System, Volume 5 for qualification requirements.

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):

Export/Domestic Airworthiness Approvals or Engines and Propellers,

Function Codes 177-179 & 188-190

Describe any experience in demonstrating eligibility for export approval of engines or propellers, or issuing aircraft export approvals for engines/propellers. Include the types of engines and/or propellers on which you gained the experience and where the experience was obtained. Refer to FAA Order 8000.95 Designee Management System, Volume 5 for qualification requirements.

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):

Export/Domestic Airworthiness Approvals of Articles, Function Codes 180 & 191

Describe any experience in demonstrating eligibility for export approval of articles, or issuing export approvals for articles. Include the types of articles on which you gained the experience and where the experience was obtained. Refer to FAA Order 8000.95 Designee Management System, Volume 5 for qualification requirements.

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):

Aging Aircraft Function Codes 197-198

Describe any experience in heavy maintenance and/or corrosion prevention and control (CPCP), structural inspections, or major repairs/modifications to airframes on aircraft operated under Part 121, 129, or 135. Include the models of aircraft, and operators where the experience was obtained. Refer to FAA Order 8000.95 Designee Management System, Volume 5 for qualification requirements.

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):

Data Approval Supporting Major Repair/Alteration of Aircraft, Function Codes 199-204

Describe any experience obtaining or issuing FAA field approvals for major repair or alteration of aircraft. Include a summary that identifies any Field Approved FAA Form 337s, in which the experience was obtained. The types of aircraft and where the experience was obtained should be included. Refer to FAA Order 8000.95 Designee Management System, Volume 5 for qualification requirements.

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):

Data Approval Supporting Major Repair/Alteration of Aircraft Engines,

Function Codes 205-208

Describe any experience obtaining or issuing FAA field approvals for major repair or alteration of aircraft engines. Include a summary that identifies any Field Approved FAA Form 337s, in which the experience was obtained. The types of aircraft engines and where the experience was obtained should be included. Refer to FAA Order 8000.95 Designee Management System, Volume 5 for qualification requirements.

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):

Blank Page for Additional Experience

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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:

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