Faa Form 8110 14 – Fill Out and Use This PDF

The FAA Form 8110-14, Statement of Qualifications, serves as a crucial document for individuals or organizations aspiring to secure designations such as Designated Engineering Representative (DER), Designated Manufacturing Inspection Representative (DMIR), or Designated Airworthiness Representative (DAR) under the U.S. Department of Transportation Federal Aviation Administration. It collects extensive information to assess an applicant's qualifications and eligibility, including personal, educational, and professional details, along with required FAA certificates. The thoughtful completion of this form is instrumental in facilitating the evaluation process and ensuring adherence to the relevant regulatory requirements. For guidance on filling out the form, click the button below.

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Faa Form 8110 14 PDF Details

In an era where aviation plays a critical role not only in transportation but also in the economy, ensuring that aircraft and related components meet rigorous safety and design standards is paramount. The Federal Aviation Administration (FAA) Form 8110-14, titled "Statement of Qualifications," serves as a fundamental tool in this process, soliciting essential information from applicants seeking designation as Designated Airworthiness Representatives (DAR), Designated Manufacturing Inspection Representatives (DMIR), or Designated Engineering Representatives (DER). Under the authority of 14 CFR Part 183, this form helps evaluate the eligibility and qualifications of applicants to ensure they can uphold the FAA's strict safety standards. Importantly, providing a Social Security Number is voluntary, aimed solely at avoiding record mix-ups. It's an application that requires meticulous attention to detail, from personal and organizational details to specific qualifications, education, training, and FAA certificates held, reflecting on the extensive and rigorous process to ensure that only the most qualified individuals are appointed. In the wider context, this form not only helps maintain high safety standards but also aligns with the FAA's commitment to transparency and efficiency in its processes. Compliance with the Paperwork Reduction Act signifies the FAA's effort to minimize the paperwork burden on the public while maintaining the integrity of its safety oversight functions.

Question	Answer
Form Name	Faa Form 8110 14
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	8110 14 faa form, 8110 statement, faa form 811014, 8110 14

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U.S. Department of Transportation

Federal Aviation Administration

INFORMATION FOR APPLICANT

STATEMENT OF QUALIFICATIONS (DAR - DMIR - DER)

Privacy Act Statement

Information on this form is solicited under authority of 14 CFR Part 183. The purpose of this information is to evaluate your application and establish your qualifications as a designee. Submission of the data is m mandatory except for your Social Security Number which is voluntary. Incomplete submission may result in delay or denial of your request. The data will be used to determine your eligibility for the designation sought, and will become part of the Privacy Act system of records DOT/FAA 830, Representatives of the Administrator, and is subject to the following routine uses as published in the Federal Register: (1) To provide the public with the names and addresses of certain categories of representatives who may provide service to them; and (2) DOT's Prefatory Statement of General Routine Uses.

The submission of your social security number is voluntary. If provided, it will be used for record keeping purposes and to help prevent your records from being confused with another person of the same name.

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 2120-0033. Public reporting for this collection of information is estimated to be approximately 30 minutes to 1 hour 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 or retain benefits per 14 CFR Part 183. 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, ASP-110.

Tear off this cover sheet before submitting this form.

FAA Form 8110-14 (1/12) Supersedes Previous Edition

FAA Form 8110-14, Statement of Qualifications

Organizations complete only the applicable blocks and attach separate resumes with the names, signatures, titles, and qualifications of those persons who would actually perform the authorized functions.

	STATEMENT OF QUALIFICATIONS					OMB-2120-0033
	STATEMENT OF QUALIFICATIONS					Expiration Date 08-31-2013
						Expiration Date 08-31-2013
US Department of Transportation			(DAR-DMIR-DER)			3. U.S. CITIZEN
Federal Aviation Administration

INSTRUCTIONS: Print or type all entries except signatures						Yes	No

1. NAME (Last, first, middle) OR ORGANIZATION

2. BUSINESS OR COMPANY ADDRESS (Number, street, city, state, and ZIP code)						4. DATE OF BIRTH

5. BUSINESS PHONE NUMBER			6. BUSINESS FAX NUMBER		7. EMAIL ADDRESS

8. DESIGNATION SOUGHT

Designated Engineering		Structural Engineering			Engine Engineering
Representative (DER)
Representative (DER)		Powerplant Engineering			Propeller Engineering

Company		Systems and Equipment Engineering			Flight Analyst

Consultant		Acoustical Engineering			Flight Test Pilot

Manufacturing Function(s)				Note:

Designated Airworthiness Representative (DAR)				A separate application must be submitted for each
				A separate application must be submitted for each
				discipline, i.e., Manufacturing or Engineering.
Designated Manufacturing Inspection Representative (DMIR)				discipline, i.e., Manufacturing or Engineering.
Designated Manufacturing Inspection Representative (DMIR)

Applicants shall identify specific function(s) for which appointment is sought:

9.EXPERIENCE RESUME FOR NUMBER OF YEARS, AS APPROPRIATE, PERTINENT TO DESIGNATION SOUGHT. (Use additional sheets if necessary)

Dates

From	To

Employer’s Name

Position Title and Duties

10. EDUCATION AND TRAINING HIGH SCHOOL LEVEL AND ABOVE PERTINENT TO DESIGNATION SOUGHT.

Dates

From	To

Name of School

Curriculum or Study Program

Degrees Received

11. FAA CERTIFICATES NOW HELD PERTINENT TO DESIGNATION SOUGHT.

Type

Certificate No.

Rating

Date Each Rating Issued

12. EMPLOYER’S RECOMMENDATION:

I recommend the person identified above be appointed as:

Designated Engineering Representative	Designated Manufacturing Inspection	Designated Airworthiness Representative
	Representative
	Representative

Date

Primary Business

Signature

13. LOCATION WHERE DESIGNEE FUNCTIONS WILL BE PERFORMED IF DIFFERENT THAN BLOCK 2.

Address

Telephone Number

EMAIL Address (Optional)

14.CERTIFICATION: I certify that the above statements are true to the best of my knowledge and that I am familiar with the Federal Aviation Regulations pertinent to the designation sought.

Date

Signature

FAA Form 8110-14 (1-12) Supersedes Previous Edition

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Faa Form 8110 14 – Fill Out and Use This PDF

Faa Form 8110 14 PDF Details

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