FAA Form 8710-6 PDF Details

In the vast and detailed world of aviation regulation and oversight, the FAA Form 8710-6 serves as a critical document, underlying the meticulous process that ensures only the most qualified individuals are granted the designation to examine and certify pilots across various categories. Known as the Examiner Designation and Qualification Record, this form bridges the gap between regulatory requirements and the practitioner’s expertise, capturing comprehensive personal and professional information ranging from basic identification details to nuanced insights into an individual’s flight experience, qualifications, and employment history. It not only acts as a record for the U.S. Department of Transportation Federal Aviation Administration but also as a testament to the holder's capabilities and history, including any past violations of Federal Aviation Regulations which might influence their standing. The procedure of applying for, renewing, or adding examiner designations is predicated on the thorough completion of this form, encompassing both the qualifications and the moral standing of the applicant within the aviation community. Underlying the formalities is a rigorous compliance framework detailed within, aimed at upholding safety and proficiency in the aviation domain, ensuring that each examiner not only meets but exceeds the standards set forth by the Federal Aviation Regulations. Furthermore, the form is enveloped in regulatory compliance measures such as the Paperwork Reduction Act statement, emphasizing the balance between necessary bureaucratic processes and the user’s convenience and protection.

QuestionAnswer
Form NameFAA Form 8710-6
Form Length3 pages
Fillable?Yes
Fillable fields138
Avg. time to fill out28 min 25 sec
Other namesdesignation additional aviation, aes form 8710, faa 8710 6, faa form 8710 6

Form Preview Example

EXAMINER DESIGNATION

U.S. Department

AND QUALIFICATION RECORD

of Transportation

 

 

Federal Aviation

 

 

Administration

 

 

Attach supplemental sheets if more space is required for any item

1. NAME (Last, first, middle)

 

Telephone No.

 

 

 

 

2.ADDRESS (Number, street, city, state, and ZIP code)

5. DO YOU NOW HOLD, OR HAVE YOU

 

YES

TYPE AND NUMBER

EVER HELD, AN EXAMINER DESIGNATION

 

NO

 

 

 

 

 

 

 

 

Form Approved OMB NO. 2120-0033 07/31/2020

 

 

 

PRIVATE PILOT

 

 

DESIGNATION

 

 

 

 

 

COMMERCIAL PILOT EXAMINER

 

 

 

 

 

 

 

 

 

 

 

 

AIRLINE TRANSPORT PILOT EXAMINER

 

 

 

 

 

 

 

 

PROFICIENCY PILOT EXAMINER

 

 

 

 

 

 

 

OF

 

FLIGHT ENGINEER EXAMINER

 

 

 

 

 

 

TYPE

 

FLIGHT INSTRUCTOR EXAMINER

 

 

 

 

 

 

 

 

OTHER

 

 

 

 

 

 

3. DATE OF BIRTH (Month, day, and year)

4. U.S. CITIZEN

YES

NO

6.HAS ANY CERTIFICATE OR RATING ISSUED YOU EVER BEEN SUSPENDED OR REVOKED OR HAVE YOU PAID A CIVIL PENALTY AS A RESULT OF A VIOLATION OF THE FEDERAL AVIATION REGULATIONS. (Complete for original designations only)

YES

NO

7. CERTIFICATES HELD

TYPE

 

CERTIFICATE NO.

 

 

 

RATINGS

DATE ISSUED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8. FLIGHT EXPERIENCE (in hours)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AIRPLANE

 

ROTORTYPE

 

GLIDERS

 

AIRSHIPS

 

INSTRUMENT

NIGHT

 

 

 

 

 

 

 

 

 

 

 

 

 

FLIGHT (Actual

 

TOTAL

LAST 12 MO

 

TOTAL

LAST 12 MO

TOTAL

LAST 12 MO

 

TOTAL

LAST 12 MO

 

FLIGHT

 

 

 

 

or sim)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PILOT-IN-COMMAND

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FLIGHT INSTRUCTION GIVEN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COPILOT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FLIGHT NAVIGATOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FLIGHT ENGINEER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.EMPLOYMENT (Indicate professional experience pertinent to this designation)

EMPLOYER'S NAME

NATURE OF WORK

DATES

TITLE OF POSITION

10. SPECIAL TRAINING PERTINENT TO THE DESIGNATION

CERTIFICATION: I certify that I am familiar with the requirements for this designation, its privileges and limitations, and that the information stated herein is true. It is understood that this designation may be terminated upon notice by the FAA for the reasons specified in section 183.15(b) of the Federal Aviation Regulations.

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 collection is 2120-0033. 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 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.

DATE

SIGNATURE

FAA Form 8710-6 (10/95) Supersedes Previous Edition

PAGE 1

NSN: 0052-00-036-7003

 

 

 

 

 

 

 

 

FOR FAA USE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TYPE OF ACTION

 

FLIGHT TEST ACTIVITIES-GENERAL AVIATION

 

 

DATE LAST REPORT

 

 

 

 

 

 

 

(Complete for renewals and additional designations)

 

 

SUBMITTED

 

 

 

 

 

 

 

 

ORIGINAL ISSUANCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL

DISAPPROVED

ACCEPTED

 

RECHECKED

NO. RETURNED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CERTIFICATES/RATINGS

BY EXAMINER

 

BY

 

 

BY

FOR

 

 

 

 

 

 

SUBMITTED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RENEWAL

 

 

 

 

 

INSPECTOR

 

INSPECTOR

CORRECTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRIVATE PILOT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDITIONAL AUTHORITY

 

COMMERCIAL PILOT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AIRLINE TRANSPORT PILOT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SPOT CHECK ONLY-

 

INSTRUMENT RATING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO RENEWAL EFFECTED

 

 

PRIVATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDITIONAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMMERCIAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REINSTATEMENT

 

RATINGS

ATR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CHARACTER AND REPUTATION (Include industry and community reputation as well as personal knowledge possessed by FAA personnel)

 

 

and

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

originalforCompleteissuance

reinstatementsonly

 

 

 

 

 

 

 

 

 

 

 

 

 

PROFESSIONAL ABILITY (Brief narrative description of examiner indoctrination and training given and results expressed as "'good," excellent or "unsatisfactory.")

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPROVE

 

 

 

 

 

INSPECTOR'S RECOMMENDATION/ACTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DISAPPROVE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

JUSTIFICATION FOR APPROVAL/REASONS FOR DISAPPROVAL

 

 

 

 

 

 

 

 

 

The individual named has been flight tested/examined and deemed competent to perform the duties of the designation indicated below.

 

 

 

 

 

CATEGORY

ADDITIONAL QUALIFICATIONS LIMITATIONS (For pilot flight engineer examiner

 

 

 

 

 

 

give aircraft category)

DESIGNATION

 

PRIVATE PILOT

 

 

AIRPLANE

 

 

 

 

 

 

 

COMMERCIAL PILOT EXAMINER

 

 

 

 

 

 

 

ROTORCRAFT

 

 

 

 

 

 

 

AIRLINE TRANSPORT PILOT EXAMINER

 

 

 

 

 

 

 

PROFICIENCY PILOT EXAMINER

 

GLIDER

 

 

 

 

 

 

 

FLIGHT ENGINEER EXAMINER

 

 

 

 

 

 

FLIGHT INSTRUCTOR EXAMINER

 

 

AIRSHIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

OFFICE NO.

INSPECTOR'S SIGNATURE

PRIVACY ACT STATEMENT. The information on this form is solicited under authority of the Federal Aviation Regulations Part 183. The purpose of this information is to establish your qualifications as an examiner. Submission of the data is mandatory. Incomplete submission may result in delay or denial of your request. The data will be used to determine your eligibility as an examiner, and for statistical purposes. In addition, the data also becomes part of the Privacy Act system of records DOT/FAA 830, Representatives of the Administrator, and is subject to the additional conditions of that published system.

DISTRICT CERTIFICATE MANAGEMENT OR REGIONAL

 

 

 

CONCUR

DATE

SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DISAPPROVE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TYPE OF DESIGNATION

 

 

CERTIFICATE OF AUTHORITY ISSUED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO.

 

DO TO SERVE UNDER

EXPIRATION DATE

 

 

 

 

 

 

 

 

 

FAA Form 8710-6 (10/95) Supersedes Previous Edition

PAGE 2

NSN: 0052-00-036-7003

 

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Step # 1 of filling out examiner date act

2. Your next step is to submit these particular blanks: TOTAL, LAST MO, TOTAL, LAST MO, TOTAL, LAST MO, TOTAL, LAST MO, INSTRUMENT FLIGHT Actual, or sim, NIGHT FLIGHT, PILOTINCOMMAND, FLIGHT INSTRUCTION GIVEN, COPILOT, and FLIGHT NAVIGATOR.

Writing part 2 in examiner date act

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SIGNATURE, Page, and DATE of examiner date act

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examiner date act conclusion process explained (part 4)

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examiner date act completion process detailed (portion 5)

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