Faa Form Certificate Details

When you are a pilot, or work in the aviation industry, there are some forms that you become very familiar with. One of those is FAA Form 8710 1. This form is used for various purposes, including issuing airmen certificates and ratings, registering aircraft, and more. In this blog post we will take a closer look at what FAA Form 8710 1 is used for, and how you can go about completing it.

Below are a few details you might want to check out just before you start dealing with the faa form 8710 1.

QuestionAnswer
Form NameFaa Form 8710 1
Form Length6 pages
Fillable?Yes
Fillable fields318
Avg. time to fill out32 min 35 sec
Other namesfaa application, faa 8710 1, faa form certificate, 8710

Form Preview Example

FAA Form 8710-1, Airman Certificate

and/or Rating Application

Supplemental Information and

Instructions

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 2120-0021. Public reporting for this collection of information is estimated to be approximately 30 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 voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth, TX 76177-1524

See attached Privacy Act Information and Pilot’s Bill of Rights Written Notification of Investigation

Detach these supplemental information instruction parts before submitting the attached form. Instructions for completing this form (FAA 8710-1 form) are attached. If an electronic form is not printed on a duplex printer, the applicant’s name, date of birth, and certificate number (if applicable) must be furnished on the reverse side of the application. This information is required for identification purposes. The applicant’s social security number, telephone number, and e-mail address are optional.

For faster processing, the FAA encourages applicants to apply online using the FAA Integrated Airman Certification and Rating Application (IACRA). IACRA is available at https://iacra.faa.gov.

Tear off this cover before submitting form

i

AIRMAN CERTIFICATE AND/OR RATING APPLICATION

PRIVACY ACT STATEMENT: This statement is provided pursuant to 5 U.S.C. § 552(a):

The authority for collecting this information is contained in 49 U.S.C. §§ 40113, 44702, 44703, 44709, 44710, 44711 (a)(2) and 14 CFR Part 61. 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 applicant's social security number which is optional. Failure to provide all required information will result in the FAA being unable to issue you a certificate and/or rating. The information 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 routine uses published in the System of Records Notice 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 certificate(s) and/or rating(s) held, limitations, date of issuance and certificatenumber;

The status of the airman’s certificate (i.e., whether it 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, 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 medical 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 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 pursuant 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 Carrier 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 individuals 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 secureenvironment.

(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 certificationdecision.

(m)Making airman, aircraft and operator record elements available to users of FAA’s Skywatch system, including the Department of Defense, the Department of Homeland Security (DHS), DOJ and other authorized Federal agencies, for their use in managing, tracking and reporting aviation-related securityevents.

(n)Other possible routine uses published in the Federal Register (see Prefatory Statement of General Routine Uses for additional uses (65 FR 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.

ii

Your signature on this form (FAA Form 8710-1) acknowledges that you received the Pilot’s

Bill of Rights Written Notification of Investigation at the time of this application.

PILOT’S BILL OF RIGHTS WRITTEN NOTIFICATION OF INVESTIGATION

The information you submit on the attached FAA Form 8710-1, Airman Certificate and/or Rating Application, will be used by the Administrator of the Federal Aviation Administration as part of the basis for issuing an airman certificate, rating, or inspection authorization to you under Title 49, United States Code (U.S.C.) section 44703(a), if the Administrator finds, after investigation, that you are qualified for, and physically able to perform the duties related to the certificate, rating, or inspection authorization for which you are applying. Therefore, in accordance with the Pilot’s Bill of Rights, the Administrator is providing you with this written notification of investigation of your qualifications for an airman certificate, rating, or inspection authorization:

The nature of the Administrator’s investigation, which is precipitated by your submission of this application, is to determine whether you meet the qualifications for the airman certificate, rating, or inspection authorization you are applying for under Title 14, Code of Federal Regulations (CFR) part 61.

Any response to an inquiry by a representative of the Administrator by you in connection with this investigation of your qualifications for an airman certificate, rating, or inspection authorization may be used as evidence against you.

A copy of your airman application file for this date is available to you upon your writtenrequest addressed to:

FEderal Aviation Administration

Airmen Certification Branch,

AFB-720 P.O. Box 25082

Oklahoma City, OK 73125-0082

(If you make a written request for your airman application file, please provide your full name, date of birth or airman certification number for identification purposes, and the date of application.)

iii

Mark “Yes” or “No” as

AIRMAN CERTIFICATE AND/OR RATING APPLICATION

INSTRUCTIONS FOR COMPLETING FAA FORM 8710-1

I. APPLICATION INFORMATION. Mark “X” in all appropriate blocks(s).

Block M3. Date Issued. Enter the date your pilot certificate was last issued.

Note: Please enter all dates in eight digits as MM/DD/YYYY.

Block N. Do You Hold, or Have You Ever Held a Medical Certificate? Mark

Use numeric characters, (e.g. 01/01/2014).

applicable boxes. If yes, complete blocks N1, N2, and N3.

Block A. Name. Enter full legal name (Last, First, Middle). If your full legal name is

Block N1. Class of Medical Certificate. Enter the class as shown on the

more than 50 characters, use no more than one middle name for record purposes. Do not

medical certificate, (i.e., First, Second, or Third Class). If your most recent medical

change the name on subsequent applications unless it is done in accordance with 14 CFR

certificate which was valid at some point after July 14th, 2006 has expired and you are

part 61.25. If you

do not have a middle name, enter “NMN.” If you have a middle

operating under BasicMed, enter “BASICMED” in this field.

initial only, indicate

“Initial only.” Indicateif you are a Jr., II, or III.

 

Block B. Social Security Number. Enter either your 9-digit social security

Block N2. Name of Medical Examiner. Enter the medical examiner’s name

number, “Do Not Use” or “None” if you are not a U.S. citizen. If entering a social

as shown on your medical certificate. If you are operating under BasicMed, leave

security number, only enter a 9-digit U.S. social security number (optional). See

blank.

supplemental Privacy Act Information.

 

 

 

Block N3. Date Issued. Enter the date your medical certificate was issued. If you are

Block C. Date of Birth. Enter your date of birth in the following format:

operating under BasicMed, leave blank.

MM/DD/YYYY. Check for accuracy. Verify that DOB is the same as it is on the

Block O. Narcotics Drugs. Mark appropriate block. Only mark “Yes” if you

medical certificate.

 

 

have actually been convicted. If you have been charged with a violation which has not

 

 

Block D. Place of Birth. If you were born in the USA, enter the city and state where

been adjudicated, mark “No.” Do not include alcohol offenses involving a motor vehicle

mode of transportation as those are covered on the FAA Form 8500-8, Medical

you were born. If the city is unknown, enter the county and state. If you were born outside

application.

the USA, enter the name of the city and country where you were born.

 

Block E1. Residential Address. Enter your complete residential address. This must

Block O1. Date of Final Conviction. If block “N” was marked “Yes” provide

include street number, city, state, and zip code. If the applicant has a foreign address, the

the date of final conviction.

country must be stated. If a residential address does not exist, a map or written directions

 

to the applicant’s physical residence must be attached to the application. Verify that the

II. CERTIFICATE OR RATING APPLIED FOR ON BASIS OF: Block

numbers are nottransposed.

A. Completion of RequiredTest.

Block E2. Mailing Address. Enter your mailing address, if different than block E1.

1. Aircraft to be used. (If flight test required) – Enter the makeand model of each

This may be a residence, post office box, rural route, flight school address, personal mail

aircraft used or represented. If a flight simulation training device (FSTD) is used,

box (PMB), commercial address, or other mail drop location, as applicable. The address

indicate Level of Device(s).

provided in block E2, if any, will be printed on the permanent airman certificate. If you

2. Total time in this aircraft and/or approved full flight simulator (FFS) or flight

want your airman certificate mailed to an address other than provided in blocks E1 or E2,

training device (FTD) (Hrs.) – (2a) Enter the total Flight Time (2b) Enter Pilot-In-

you will need to provide instructions on a separate attachment or in the remarks section

Command (PIC) Flight Time.

of the form.

 

 

Block F. Citizenship/Nationality. Mark USA if you are a U.S. Citizen or

Block B. U.S. Military Competence Or Experience. Enter your branch of

service, date rated as a U.S. military pilot, and your rank or grade. In block 4a and 4b,

legally naturalized U.S. Citizen. If you are not a U.S. citizen, mark “Other” and enter

enter the make and model of each military manned aircraft used to qualify (as

the country where you are a legal citizen. To claim Dual Citizenship the applicant

appropriate). ATD, FTD, or FFS time cannot be used.

must present appropriate documentation of citizenship for each country.

 

Block G. Do you read, speak, write and understand the English language?

Block C. Graduate of an Approved Course.

1. Name, Location, Certification Number of Training Agency/Center, as shown on the

Mark yes or no. If you answered “No” and it is due to medical reasons, an operating

graduation certificate. Indicate if this was a part 142 training center.

limitation will be placed on the airman certificate.

2. Curriculum From Which Graduated. Enter name of curriculum and level,

 

 

Block H. Height. Enter your height in inches. Example: 5’8” would be entered as

category, and/or type rating, asapplicable.

3. Date. Date of graduation from indicatedcourse.

68 in. No fractions, use whole inches only.

 

Block I. Weight. Enter your weight in pounds. No fractions, use whole pounds

Note: Approved course graduate must also complete block A “Completion of

Test or Activity,” if the course is not part of an Air Agency or a part 142

 

 

only.

 

Training Center.

Block J. Hair Color. Spell out the color of your hair. Choose from the following:

Block D. Holder of Foreign License.

bald, black, blond, brown, gray, red or white. If you wear a wig or toupee, enter the color

1. Country that Issued the Foreign PilotLicense.

of your hair under the wig or toupee.

2. Grade Of Foreign Pilot License (i.e. private, commercial,etc).

 

 

Block K. Eye Color. Spell out the color of your eyes. Choose from the following:

3. Number. Number which appears on the foreign license.

4. Ratings. Enter the FAA equivalent only ratings that appear on the foreign license.

black, blue, brown, gray, green, or hazel.

Indicate the ratings as they will appear on the FAA Certificate (i.e. ASEL, AMEL,

 

 

Block L. Sex. Mark either Male or Female as appropriate.

ROTORCRAFT HELICOPTER, CE-500,etc).

Block M. Do You Hold or Have You Ever Held An FAA Pilot Certificate? Mark yes or no. (NOTE: A student pilot certificate is a pilot certificate.) If. Yes, complete Blocks M1, M2, and M3.

Block M1. Grade of Certificate. Enter the grade of the FAA pilot certificate you hold (i.e., Student, Recreational, Private, Commercial, or ATP). DO NOT enter flight instructor certificate information.

Block M2. Certificate Number. Enter your current FAA certificate number as it appears on the pilot certificate.

Block E. Completion of Air Carrier’s Training Program.

1.Name of air carrier.

2.Date program was started.

3.Identify the training programaccomplished.

III.RECORD OF PILOT TIME. At a minimum, the applicant should complete the blocks applicable to the certificate or rating sought; however, it is recommended that all pilot time be entered. If decimal points are utilized, ensure that they are legible. Time entered in the “Class Totals” block should reflect time in aircraft class for the certificate or rating sought with this application. The time entered for an FFS, FTD, and/or ATD may be credited towards the total time in the category, class, and instrument time as permitted by the regulations. Add any Flight Engineer time used for ATP in remarks section.

IV. HAVE YOU PREVIOUSLY RECEIVED A NOTICE OF DISAPPROVAL OR BEEN DENIED FOR ANY REASON FOR THE CERTIFICATE AND/OR RATING

FOR WHICH YOU ARE APPLYING?

appropriate.

V.APPLICANT’S CERTIFICATION.

A.Signature. Sign yourname.

B.Date. The date you signed the application.

FAA Form 8710-1 (10-17) Supersedes Previous Edition

iv

Form approved OMB No: 2120-0021

TYPE OR PRINT ALL ENTRIES IN INK

Exp 04/30/2022

Airman Certificate and/or Rating Application

I.APPLICATION INFORMATION (Mark ‘X’ in all the blocks applicable to the certificate or rating for which you are applying):

 

 

 

 

 

Certificates

 

 

 

 

 

 

 

 

 

 

 

 

Ratings

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Information/Requests

 

 

 

 

 

Pilot:

 

 

 

 

 

Instructor:

Category and/or Class:

 

 

 

 

 

 

 

 

Instrument:

Ground Instructor:

 

 

Initial

 

 

 

 

Reexamination

 

Instrument Proficiency Check

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Student

Recreational

 

 

Flight

 

 

ASE

 

AME

 

 

Land

 

 

Sea

 

 

 

Airplane

 

 

Basic

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Renewal

 

 

 

 

Reissuance

 

Medical Flight Test

 

 

 

Private

Commercial

 

 

Ground

 

 

Helicopter

 

Balloon

 

 

Glider

 

 

 

Helicopter

 

 

Advanced

 

 

Reinstatement

 

 

Flight Review

 

Limitation Removal

 

 

 

ATP-Restricted

ATP

 

 

 

 

Gyroplane

 

Airship

 

 

Powered-Lift

 

 

 

Powered-Lift

 

 

Instrument

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type Rating:

 

 

 

Added Rating

 

 

 

 

 

 

 

 

 

 

 

 

 

Specify other:

 

 

 

 

 

 

 

 

 

IPL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. Name (Last, First, Middle)

 

 

 

 

 

 

 

 

 

 

 

 

B. SSN (US Only)

 

 

 

 

C. Date of Birth

 

 

 

D. Place of Birth (City and State) or (City and Country)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM/DD/YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E1.

Residential Address

 

 

 

 

 

 

 

 

E2. Mailing Address (This address will be printed on the

F. Citizenship / Nationality

 

G. Do you read,

 

 

 

 

Yes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Including City, State, Zip Code, and Country)

 

 

 

 

permanent airman certificate, if different than block E1.)

 

 

 

 

 

USA

 

 

 

Other

 

 

 

speak, write, &

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

understand the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

specify:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

English language?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

H. Height

I. Weight

J. Hair Color

 

K. Eye Color

 

L. Sex

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(inches)

(pounds)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Male

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Female

M. Do you hold, or have you ever held an FAA pilot certificate?

M1. Grade of Certificate

 

M2. Certificate Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M3. Date Issued

 

 

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N. Do you hold, or have you ever held a Medical Certificate?

N1. Class of Certificate

 

N2. Name of Medical Examiner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N3. Date Issued

 

 

 

 

Yes - FAA

 

Yes - Foreign

 

 

Yes - Military

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

O. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, or depressant or stimulant drugs or substances? Do not include alcohol offenses involving

 

O1. Date of Final Conviction

motor vehicle mode of transportation as those offenses are covered on the FAA Form 8500-8, Airman Medical Application Form.

 

 

 

Yes

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

II. CERTIFICATE OR RATING APPLIED FOR ON BASIS OF:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A.

Completion of

1. Aircraft to be used (If flight test required)

 

 

 

 

 

 

 

 

 

 

2. Total time in this aircraft and/or

a. Flight

 

 

 

 

 

 

 

 

 

b. As Pilot-in-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Test or Activity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

approved FFS or FTD (hours):

 

 

 

 

Time

 

 

 

 

 

 

 

 

 

 

Command

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

U.S. Military

 

1. U.S. Military Service

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Date Rated in U.S. Military

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. Rank or Grade

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. Competence or

 

4. List Military aircraft

a. logged pilot time or provided flight instruction (IP) (make and model)

b. passed an Instrument Proficiency Check (Pilot or CFI) - (make and model)

 

 

 

 

 

Experience

 

 

 

 

 

 

 

for which you have:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Graduate of an

 

1.Training Agency

1a. Name

 

 

 

 

 

 

 

 

 

 

1b. Location (City and State)

1c. Certification Number

 

 

 

 

 

1d. Part 142?

 

 

 

 

 

 

or Training Center:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

No

 

 

 

 

C.

Approved

 

 

2. Curriculum From Which Graduated (Level, Category, and Class and/or Type Rating)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. Date

 

 

 

 

 

 

 

 

 

Course

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Holder of

 

 

1. Country that Issued the Foreign Pilot License

 

 

 

 

2. Grade of Foreign Pilot License

 

 

 

 

3. Foreign Pilot License Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D.

Foreign

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Ratings Held on Foreign Pilot License (FAA equivalent only – e.g. ASEL, AMEL, Type rating, etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

License

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Air Carrier

 

 

1. Name of Air Carrier

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Date Training Began

3. Accomplished Training Program

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E.Training Program

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Initial

 

 

Upgrade

 

Transition

 

 

 

Recurrent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

III.RECORD OF PILOT TIME (Do not write in the shaded areas)

 

Instruction

 

PIC

Cross Country

Cross Country

Cross Country

 

Night

Night

Night

 

Night

 

Number of

 

 

 

 

 

 

 

Take-

 

 

 

 

 

Total

Solo

and

Instruction

Instrument

Instruction

Take-Off /

 

 

 

 

 

 

Received

Solo

PIC/SIC

PIC/SIC

 

Off/Landing

 

 

 

Ground

Powered

 

 

SIC

Received

 

Received

Landing

 

Flights

Aero-Tows

 

 

 

 

 

 

 

 

 

PIC/SIC

Launches

Launches

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PIC

 

 

PIC

 

 

 

PIC

PIC

 

Gliders

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Airplanes

 

 

SIC

 

 

SIC

 

 

 

SIC

SIC

 

Lighter-than-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

air

 

 

 

 

 

 

 

PIC

 

 

PIC

 

 

 

PIC

PIC

 

 

Class Totals

 

 

Rotorcraft

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIC

 

 

SIC

 

 

 

SIC

SIC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SEL

MEL

 

SES

MES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PIC

 

 

PIC

 

 

 

PIC

PIC

 

PIC

PIC

PIC

 

PIC

Powered

 

 

 

 

 

 

 

 

 

 

 

 

Airplane

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lift

 

 

SIC

 

 

SIC

 

 

 

SIC

SIC

 

SIC

SIC

SIC

 

SIC

 

 

 

PIC

 

 

 

 

 

 

 

 

 

Helicopter

 

Gyroplane

Gliders

 

 

SIC

 

 

 

 

 

 

 

 

 

Rotorcraft

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lighter-

 

 

PIC

 

 

PIC

 

 

 

PIC

PIC

 

Balloon

 

Airship

 

 

 

 

 

 

 

 

 

 

 

 

Lighter-than-

 

 

 

 

Than-Air

 

 

SIC

 

 

SIC

 

 

 

SIC

SIC

 

air

 

 

 

 

FFS

 

 

 

 

 

 

 

 

 

 

 

 

SE

ME

 

Helicopter

 

 

 

 

 

 

 

 

 

 

 

 

FFS

 

 

 

 

FTD

 

 

 

 

 

 

 

 

 

 

 

 

FTD

 

 

 

 

ATD

 

 

 

 

 

 

 

 

 

 

 

 

ATD

 

 

 

 

IV. Have you previously received a Notice of Disapproval or been denied for any reason for the certificate AND/OR rating for which you are applying?

Yes

No

 

 

 

 

V.APPLICANT’S CERTIFICATION: I certify that all statements and answers provided by me on this application form are complete and true to the best of my knowledge and I agree that they are to be considered as part of the basis for issuance of any FAA certificate to me. I have received the Pilot’s Bill of Rights Written Notification of Investigation that accompanies this form. I have also read and understand the Privacy Act statement that accompanies this form.

Signature of Applicant

Date

MM/DD/YYYY

FAA Form 8710-1 (10-17) Supersedes Previous Edition

Page 1 of 2

Instructor Action

Accepted Student Pilot Application – I have personally reviewed the applicant’s information and verified the person meets the eligibility requirements and verified applicants identification

Rejected Student Pilot Application

 

 

Flight Review

 

Instrument Proficiency Check

 

Recommendation - I have personally instructed the applicant and consider this person ready to take the test.

 

 

 

 

 

 

Date

 

Authorized Flight Instructor’s Signature (Print Name and Sign)

Flight Instructor Certificate Number

Certificate Expiration Date

 

 

 

 

 

 

 

 

 

Air Agency’s Recommendation

The applicant has successfully completed our _______________________________________________________________ course, and is recommended for certificate or rating without further practical test.

Date

Agency Name and Number

Official Signature

 

Designated Examiner or Airman Certification Representative Report

Accepted Student Pilot Application

Rejected Student Pilot Application

I have personally reviewed this applicant’s pilot logbook and/or training record, and I certify that the individual meets the applicable requirements of 14 CFR Part 61 for the certificate or rating sought. I have personally reviewed this applicant’s graduation certificate, and found it to be appropriate and in order, and have returned the certificate. (Original ATP CTP graduation certificate must be attached)

 

 

I have personally tested and/or verified this applicant in accordance with pertinent procedures and standards with the result indicated below.

 

 

 

 

 

 

 

 

I have personally delivered the Written Notification under the Pilot’s Bill of Rights to the applicant.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Approved – Temporary Certificate Issued (Original Attached)

 

Disapproved – Disapproval Notice Issued (Original Attached)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Location of Test (Name of Facility or Airport, City, State)

 

 

 

 

Duration of Test

 

 

 

 

 

 

 

 

 

 

Ground / Oral

 

FFS / FTD

Flight

 

 

 

 

 

 

 

 

 

 

 

 

 

Certificate or Rating Being Applied For (Grade, Category, Class and/or Type Rating)

Type(s) of Aircraft Used

Registration Number(s)

Date

Examiner’s Signature (Print Name & Sign)

Certificate Number

Designation Number

Designation Expires

Evaluator’s Record (Use for All ATP Certificate(s) and/or Type Rating(s))

Inspector

Examiner

Signature and Certificate Number

Date

Ground / Oral

________________________________________________________________________________

Approved FFS/FTD Check

________________________________________________________________________________

Aircraft Flight Check

________________________________________________________________________________

Advanced Qualification Program

________________________________________________________________________________

Aviation Safety Inspector or Technician Report

I have personally tested this applicant in accordance with or have otherwise verified that this applicant complies with, pertinent procedures, standards, policies, and or necessary requirements with the result indicated below. (The approved box need only checked if the Inspector is the one that issued the temporary airman certificate)

 

 

 

 

 

 

I have personally delivered the Written Notification under the Pilot’s Bill of Rights to the applicant.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Approved – Temporary Certificate Issued (Original Attached)

 

Disapproved – Disapproval Notice Issued (Original Attached)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Accepted - Student Pilot Application

 

 

 

 

 

Rejected - Student Pilot Application

Location of Test (Name of Facility or Airport, City, State)

 

 

 

Duration of Practical Test

 

 

 

 

 

 

 

 

 

 

Ground / Oral

FFS / FTD

 

Flight

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Certificate or Rating Being Applied For (Grade, Category, Class and/or Type Rating)

Type(s) of Aircraft Used

Registration No.(s)

Certification Activities:

Examiner’s Recommendation Provided/Reviewed

Accepted Rejected

Application for Student Pilot Certificate Accepted

Reissue or exchange of pilot, CFI, or G.I. certificate

Change of name, nationality, gender or date of birth

SIC Type Rating issued under § 61.55(b) (Part 91)

Ground Instructor Certificate Issued Basic

Advanced

Instrument

Flight Instructor Certificate Issued

Initial Renewal Reinstatement

Instructor Renewal Based On:

Activity Training Course

Test

 

Duties and Responsibilities

Military Instructor Proficiency Check

Certificate or Rating Based on:

Approved FAA Qualification Criteria not Identified on Page 1

Military Competency

 

Foreign License

Special medical test conducted – report forwarded to issuing medical office or AAM-300

Special Test-Reexamination (44709) conducted

Approved Disapproved

Training Course (FIRC) Name

Graduation Certificate Number

 

Date of FIRC Graduation Certificate

 

 

 

 

 

Date

Inspector’s Signature (Print Name & Sign)

 

Certificate Number

FAA Office (e.g. SO-15, WP-19)

 

 

 

 

 

Attachments:

 

Airman’s Identification (ID) (US driver’s license or passport recommended)

Applicant Information (required if printed on 2 pages)

 

 

 

 

Certifying Statement

 

 

 

 

 

 

 

 

 

 

Form of ID

 

 

Name

 

 

College Transcript (Official)

 

 

 

 

 

 

 

 

 

 

 

ID Number (If issued by State, include State)

 

 

Date of Birth

 

 

ATP CTP Graduation Certificate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Knowledge Test Report

 

Expiration Date (must be valid)

 

 

Certificate Number

 

Temporary Airman Certificate

 

 

 

 

 

 

 

 

 

Notice of Disapproval

 

Telephone Number

 

 

E-Mail Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Meets Aviation English Language Standard

 

Does Not Meet Aviation English Language Standard

 

Referred to FSO for Aviation English Language

 

Superseded Airman Certificate

 

REMARKS:

 

 

 

 

Standard Determination

FAA Form 8710-1 (10-17) Supersedes Previous Edition

Page 2 of 2

How to Edit Faa Form 8710 1

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stage 1 to writing form 8710 1

Put the requested data in the Holder of Foreign License, Training Program, Air Carrier, Initial, Upgrade Transition, Recurrent, III, Total, Instruction Received, Solo, PIC and SIC, Cross Country, Instruction Received, Cross Country, and Cross Country segment.

Entering details in form 8710 1 part 2

Put down the demanded particulars when you find yourself within the Date, FAA Form 8710-1 (10-17) Supersedes, MM/DD/YYYY, and Page 1 of 2 segment.

form 8710 1 Date, FAA Form 8710-1 (10-17) Supersedes, MM/DD/YYYY, and Page 1 of 2 blanks to fill

In paragraph Flight Review, Instrument Proficiency Check, Recommendation - I have personally, Date, Authorized Flight Instructor’s, Flight Instructor Certificate, Certificate Expiration Date, The applicant has successfully, Date, Agency Name and Number, Official Signature, Air Agency’s Recommendation, Designated Examiner or Airman, Accepted Student Pilot Application, and Rejected Student Pilot Application, identify the rights and obligations.

form 8710 1 Flight Review, Instrument Proficiency Check, Recommendation - I have personally, Date, Authorized Flight Instructor’s, Flight Instructor Certificate, Certificate Expiration Date, The applicant has successfully, Date, Agency Name and Number, Official Signature, Air Agency’s Recommendation, Designated Examiner or Airman, Accepted Student Pilot Application, and Rejected Student Pilot Application fields to fill

Finish the document by checking these areas: Accepted - Student Pilot, Location of Test (Name of Facility, Rejected - Student Pilot, Duration of Practical Test, Ground / Oral, FFS / FTD, Flight, Certificate or Rating Being, Type(s) of Aircraft Used, Registration No, Certification Activities:, Examiner’s Recommendation, Accepted Rejected, Application for Student Pilot, and Reissue or exchange of pilot.

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