PRIVACY ACT STATEMENT: This statement is provided pursuant to the Privacy Act of 1974, 5 USC § 552a:
The authority for collecting this information is contained in 49 U.S.C. §§ 40113, 44702, 44703, 44709 and 14 C.F.R. Part 6 5. The principal purpose for which the information is
intended to be used is to identify and evaluate your qualifications and eligibility for the issuance of an airman certificate and/or rating. Submission of the data is mandatory, except
for the Social Security Number, which is voluntary. Failure to provide all required information will result in our being unable to issue you a certificate and/or rating. The informa-
tion collected on this form will be included in a Privacy Act System of Records known as DOT/FAA 847, titled “Aviation Records on Individuals” and will be subject to the rou-
tine uses published in the System of Records Notice (SORN) for DOT/FAA 847 (see www.dot.gov/privacy/privacyactnotices), including:
(a) Providing basic airmen certification and qualification information to the public upon request; examples of basic information include:
• The type of certificates and ratings held, limitations, date of issuance and certificate number;
• The status of the airman’s certificate (i.e., whether it is current or has been amended, modified, suspended or revoked for any reason);
• The airman’s home address, unless requested by the airman to be withheld from public disclosure per 49 U.S.C. 44703(c);
• Information relating to an airman’s physical status or condition used to determine statistically the validity of FAA medical standards; and the date, class, and restrictions of the
latest physical
• Information relating to an individual’s eligibility for medical certification, requests for exemption from medical requirements, and requests for review of certificate denials.
(b) Using contact information to inform airmen of meetings and seminars conducted by the FAA regarding aviation safety.
(c) Disclosing information to the National Transportation Safety Board (NTSB) in connection with its investigation responsibilities.
(d) Providing information about airmen to Federal, State, local and tribal law enforcement agencies when engaged in an official investigation in which an airman is involved.
(e) Providing information about enforcement actions, or orders issued thereunder, to Federal agencies, the aviation industry, and the public upon request.
(f) Making records of delinquent civil penalties owed to the FAA available to the U.S. Department of the Treasury and the U.S. Department of Justice (DOJ) for collection pursu-
ant to 31 U.S.C. 3711(g).
(g) Making records of effective orders against the certificates of airmen available to their employers if the airmen use the affected certificates to perform job responsibilities for
those employers.
(h) Making airmen records available to users of FAA’s Safety Performance Analysis System (SPAS), including the Department of Defense Commercial Airlift Division’s Air Car-
rier Analysis Support System (ACAS) for its use in identifying safety hazards and risk areas, targeting inspection efforts for certificate holders of greatest risk, and monitoring the
effectiveness of targeted oversight actions.
(i) Making records of an individual’s positive drug test result, alcohol test result of 0.04 or greater breath alcohol concentration, or refusal to submit to testing required under a
DOT-required testing program, available to third parties, including current and prospective employers of such individuals. Such records also contain the names and titles of indi-
viduals who, in their commercial capacity, administer the drug and alcohol testing programs of aviation entities.
(j) Providing information about airmen through the Civil Aviation Registry’s Comprehensive Airmen Information System to the Department of Health and Human Services, Office
of Child Support Enforcement, and the Federal Parent Locator Service that locates noncustodial parents who owe child support. Records in this system are used to identify airmen
to the child support agencies nationwide in enforcing child support obligations, establishing paternity, establishing and modifying support orders and location of obligors. Records
listed within the section on Categories of Records are retrieved using Connect: Direct through the Social Security Administration’s secure environment.
(k) Making personally identifiable information about airmen available to other Federal agencies for the purpose of verifying the accuracy and completeness of medical information
provided to FAA in connection with applications for airmen medical certification.
(l) Making records of past airman medical certification history data available to Aviation Medical Examiners (AMEs) on a routine basis so that AMEs may render the best medical
certification decision.
(m) Making airman, aircraft and operator record elements available to users of FAA’s Skywatch system, including the Department of Defense (DoD), the Department of Homeland
Security (DHS), DOJ and other authorized Federal agencies, for their use in managing, tracking and reporting aviation-related security events.
(n) Other possible routine uses published in the Federal Register (see Prefatory Statement of General Routine Uses for additional uses (65 F.R. 19477-78) For example, a record from
this system of records may be disclosed to the United States Coast Guard (Coast Guard) and to the Transportation Security Administration (TSA) if information from this system
was shared with either agency when that agency was a component of the Department of Transportation (DOT) before its transfer to DHS and such disclosure is necessary to
accomplish a DOT, TSA or Coast Guard function related to this system of records.
AIRMAN CERTIFICATE AND/OR RATING APPLICATION
FAA Form 8610-2 (2-85)
U.S. Department of Transportation
Federal Aviation Administration
TEAR OFF
BEFORE USE
SUPPLEMENTAL
INFORMATION
Paperwork Reduction Act Statement: A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a
person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless
that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0022.
Public reporting for this collection of information is estimated to be approximately 20 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information.
All responses to this collection of information are required to obtain a benefit per 14 CFR Part 65. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden to the FAA at: 800 Independence Ave. SW,
Washington, DC 20591, Attn: Information Collection Clearance Officer, AES-200.
FAA Form 8610-2
(2-85)
Electronic Version (Adobe)
TYPE OR PRINT ALL ENTRIES IN INK
Form Approved
OMB. No. 2120-0022 12/31/2020
U.S. Department of Transportation
Federal Aviation Administration
AIRMAN CERTIFICATE AND/OR RATING APPLICATION
MECHANIC
AIRFRAME
POWERPLANT
REPAIRMAN
(Specify Rating)
PARACHUTE RIGGER
SENIOR MASTER
SEAT
'
BACK
CHEST
LAP
APPLICATION FOR: ORIGINAL ISSUANCE ADDED RATING
I. APPLICANT INFORMATION
A. NAME (First, Middle, Last)
B. SOCIAL SECURITY NO. C. DOB (Mo., Day., Yr.) D. HEIGHT
IN.
E. WEIGHT
F. HAIR G. EYES H. SEX I. NATIONALITY (Citizenship)
J. PLACE OF BIRTH
K. PERMANENT MAILING ADDRESS
NUMBER AND STREET, P.O. BOX, ETC.
CITY
STATE ZIP CODE
L. HAVE YOU EVER HAD AN AIRMAN CERTIFICATE SUSPENDED OR REVOKED?
NO
YES (If "Yes," explain on an attached sheet keying to appropriate item number).
M. DO YOU NOW OR HAVE YOU EVER HELD AN FAA AIRMAN
CERTIFICATE?
NO YES
SPECIFY TYPE:
N. HAVE YOU EVER BEEN CONVICTED FOR VIOLATION OF ANY FEDERAL OR STATE STATUTES
PERTAINING TO NARCOTIC DRUGS, MARIJUANA, AND DEPRESSANT OR STIMULANT
DRUGS OR SUBSTANCES? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NO YES
DATE OF FINAL CONVICTION
II. CERTIFICATE OR
RATI
NG APPLIED FO
R
O
N BASIS OF -
A. CIVIL
EXPERIENCE
B. MILITARY
EXPERIENCE
C. LETTER OF RECOMMENDATION FOR
REPAIRMAN (Attach copy)
D. GRADUATE
OF APPROVED
COURSE
(1) NAME AND LOCATION OF SCHOOL
(2) SCHOOL NO. (3) CURRICULUM FROM WHICH GRADUATED (4) DATE
E. STUDENT HAS MADE SATISFACTORY PROGRESS
AND IS RECOMMENDED TO TAKE THE ORAL/
PRACTICAL TEST (FAR 65.80)
(1) SCHOOL NAME NO. (2) SCHOOL OFFICIAL'S SIGNATURE
F. SPECIAL AUTHORIZATION TO TAKE
MECHANIC'S ORAL/PRACTICAL TEST
(FAR 65.80)
(1) DATE AUTH.
(2) DATE AUTH. EXPIRES
(3) FAA INSPECTOR SIGNATURE
(4) FAA DIST OFC.
III. RECORD OF EXPERIENCE
A. MILITARY
COMPETANCE
OBTAINED IN
(1) SERVICE (2) RANK OR PAY LEVEL (3) MILITARY SPECIALITY CODE
B. APPLICANT'S OTHER THAN FAA CERTIFICATED SCHOOL GRADUATES. LIST EXPERIENCE RELATING TO CERTIFICATE AND RATING APPLIED FOR.
(Continue on separate sheet, if more space is needed).
DATES: MONTH AND YEAR
FROM TO
EMPLOYER AND LOCATION TYPE WORK PERFORMED
C. PARACHUTE RIGGER APPLICANTS:
INDICATE BY TYPE HOW MANY
PARACHUTES PACKED
SEAT CHEST BACK LAP
FOR
MASTER
RATING
ONLY
PACKED AS A -
SENIOR
RIGGER
MILITARY
RIGGER
IV. APPLICANT'S
CERTIFICATION
I CERTIFY THAT THE STATEMENTS BY ME ON THIS APPLICATION ARE TRUE
A. SIGNATURE B. DATE
I FIND THIS APPLICANT MEETS THE EXPER-
V.
IENCE REQUIREMENTS OF FAR 65 AND IS
ELIGIBLE TO TAKE THE REQUIRED TESTS.
DATE INSPECTOR'S SIGNATURE FAA DISTRICT OFFICE
FOR FAA USE ONLY
Emp. .reg. D.O. .seal .con iss. Act .lev .TR .s.h. .Src #rte Rating (1) Rating (2) Rating (3) Rating (4)
LIMITATIONS
FAA Form 8610-2 (2-85) SUPERSEDES PREVIOUS EDITION
Electronic Version (Adobe)
POWERPLANT
AIRFRAME
REPAIRMAN
MECHANIC
BACK
SEAT
PARACHUTE RIGGER
LAP
CHEST
MASTER
Results of Oral and Practical Tests
MECHANIC PARACHUTE RIGGER
I. GENERAL - Airframe and powerplant
ORAL TEST PASS
EXPIRATION
DATE:
FAIL
SEAT
BACK
PASS
PASS
FAIL
FAIL
QUES.
NO.
TYPE
CHEST
PASS FAIL
PRACTICAL TEST PASS
EXPIRATION
DATE:
FAIL
LAP
PASS FAIL
PROJ.
NO.
PASS FAIL
II. AIRFRAME STRUCTURES
REMARKS
ORAL TEST PASS
EXPIRATION
DATE:
FAIL
QUES.
NO.
PRACTICAL TEST PASS
EXPIRATION
DATE:
FAIL
PROJ.
NO.
III. AIRFRAME SYSTEMS AND COMPONENTS
ORAL TEST PASS
EXPIRATION
DATE:
FAIL
QUES.
NO.
PRACTICAL TEST
PASS
EXPIRATION
DATE:
FAIL
PROJ.
NO.
IV. POWERPLANT THEORY AND MAINTENANCE
ORAL TEST PASS
EXPIRATION
DATE:
FAIL
QUES.
NO.
PRACTICAL TEST PASS
EXPIRATION
DATE:
FAIL
PROJ.
NO.
V. POWERPLANT SYSTEMS AND COMPONENTS
ORAL TEST PASS
EXPIRATION
DATE:
FAIL
QUES.
NO.
PRACTICAL TEST PASS
EXPIRATION
DATE:
FAIL
PROJ.
NO.
DESIGNATED EXAMINER'S REPORT
I have personally tested this applicant in accordance with pertinent procedures and standards, and
I HAVE INDICATED
THE RESULT AS:
APPROVED (Temporary Certificate Issued)
DISAPPROVED
APPROVED (Temporary Certificate NOT Issued)
FAR 65.80 - ORAL/PRACTICAL PASSED
ATTACH-
MENTS:
REPORT OF WRITTEN TEST SUPERSEDED CERTIFICATE LETTER
FAA FORM 8610-2 TEMPORARY CERTIFICATE SEAL SYMBOL CARD
DATE TEST COMPLETED EXAMINER'S SIGNATURE DESIGNATION NO.
APPLICANT'S CERTIFICATIONAPPLICANT'S CERTIFICATION
THIS BLOCK MUST BE COMPLETED BY THE APPLICANT AT THE TIME OF ISSUANCE OF TEMPORARY CERTIFICATE (FAA FORM 8060-4)
A. HAVE YOU EVER HAD AN AIRMAN CERTIFICATE SUSPENDED OR REVOKED? . . . . . . . . . . . . . . .
NO Yes If "Yes," explain on an attached sheet.
B. HAVE YOU EVER BEEN CONVICTED FOR VIOLATION OF ANY FEDERAL OR STATES STATUTES
PERTAINING TO NARCOTIC DRUGS, MARIJUANA, DEPRESSANT OR STIMULANT
DRUGS OR SUBSTANCES? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NO YES
DATE OF FINAL CONVICTION
I CERTIFY THAT THE STATEMENTS BY ME ARE TRUE.
A. SIGNATURE
B. DATE
FAA INSPECTOR'S REPORT
I HAVE -
EXAMINED THIS APPLICANT'S PAPERS.
PERSONALLY TESTED THIS APPLICANT IN
ACCORDANCE WITH PERTINENT PROCEDURES
AND STANDARDS.
DATE
WITH THE INDICATED RESULT -
APPROVED
DISAPPROVED
INSPECTOR'S SIGNATURE
PARACHUTE SEAL
SYMBOL ASSIGNED
ANSWER SHEET GRADED
(Military Competency)
FAA DISTRICT OFFICE
Electronic Version (Adobe)