8610-2 Airman Certificate and/or Rating Application - Mechanic

FAA Form 8610-2, Airman Certificate and/or Rating Application – Mechanic and
Parachute Rigger (14 CFR Part 65),
Supplemental Information
The supplemental information for this form includes the following:
Page i………………..
Page ii……………….
Page iii………………
Page iv……………...
Page v………………..

Paperwork Reduction Act Burden Statement
Privacy Act Statement
Pilot’s Bill of Rights Written Notification of Investigation
Instructions for Completing FAA Form 8610-2
Instructions for Completing FAA Form 8610-2, continued.

Detach these supplemental information and instruction parts before submitting the attached form.
An electronic, fillable, printable version of FAA Form 8610-2 is available at www.faa.gov.
When printing, print pages 6 through 7, if you choose to print only the form.
Printing double-sided is preferable. If the form is not printed in the double-sided format, complete
the “Applicant Information” section on the top of page 2.
Integrated Airman Certification and Rating Application (IACRA) is a web-based certification/rating
application that guides the user through the FAA's airman application process. IACRA helps ensure
applicants meet regulatory and policy requirements through the use of extensive data validation. It
also uses electronic signatures to protect the information's integrity, eliminates paper forms, and
prints temporary certificates. IACRA can be accessed here: https//iacra.faa.gov.
• All applicants must establish an FAA Tracking Number (FTN) within the Integrated Airman
Certification and Rating Application (IACRA) system before taking any FAA airman
knowledge test.
• The FTN is an 8-digit unique and permanent number assigned to each FAA certificate holder.
This identification number will be printed on the applicant’s Airman Knowledge Test Report
(AKTR) in replacement of the Applicant ID number.
• To register for an FTN in IACRA, applicants will need to visit the IACRA website and follow
the instructions provided.
• If you have been issued an FAA airman certificate in the past, then you already have a FTN.
To find your FTN, you must enter your certificate number during the IACRA registration
process.

OMB CONTROL NUMBER: 2120-0022
EXPIRATION DATE: 03/31/2025
Paperwork Reduction Act Burden 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, and
completing and reviewing the collection of information.
All responses to this collection of information are required to obtain or retain a benefit under
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: Information
Collection Clearance Officer, Federal Aviation Administration, 10101 Hillwood Parkway,
Fort Worth, TX 76177-1524
FAA Form 8610-2 (XX-22) SUPERSEDES PREVIOUS EDITION
Detach this supplemental information before using the attached form
i

FAA Form 8610-2, Airman Certificate and/or Rating Application – Mechanic and
Parachute Rigger (14 CFR Part 65),
Supplemental Information

Privacy Act Statement
Privacy Act Statement (5 U.S.C. § 552a, as amended):
Authority: The information collected on the FAA Form 8610-2 – Airman Certificate and/orRating Application – Mechanic and Parachute Rigger (14 CFR
Part 65), is in accordance with 49 U.S.C. §§ 106(g), 40113, 44702, 44703, 44709, 44710, 44711(a)(2) and 14 CFR Parts 65.
Purpose: The information collected will be used to identify and evaluate your qualifications and eligibility for the issuance of a mechanic certificate,
parachute rigger certificate, and/or added rating.
Routine Uses: The information collected on this form is included in a Privacy Act System of Records DOT/FAA 847, Aviation Records on Individuals, and
is subject to the routine uses published in the Federal Register (75 FR 68849-52 - Nov. 9, 2010) including;
•
Providing basic airmen certification and qualification information to the public upon request; examples of basic information include:
•
The type of certificates and rating held;
•
The date, class, and restrictions of the latest physical airman’s 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 individual’s physical status or condition used to determine statistically the validity of FAA medical
standards; and
•
Information relating to an individual’s eligibility for medical certification, requests for exemption from medical requirements, and
requests for review of certificate denials.
•
Using contact information to inform airmen of meetings and seminars conducted by the FAA regarding aviation safety.
•
Disclosing information to the National Transportation Safety Board (NTSB) in connection with its investigation responsibilities.
•
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.
•
Providing information about enforcement actions, or orders issued thereunder, to government agencies, the aviation industry, and the public upon
request.
•
Making records of delinquent civil penalties owed to the FAA available to the U.S. Department of the Treasury (Treasury) and the U.S.
Department of Justice (DOJ) for collection pursuant to 31 U.S.C. 3711(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.
•
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.
•
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 employers 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.
•
Providing information about airmen through the airmen registry certification system to the Department of Health and Human Services, Office to
the Child Support Enforcement, and the Federal Parent Locator Service that locates non-custodial 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 paternities,
establishing and modifying support orders and location of obligors. Records named within the section on Categories of Records will be retrieved
using Connect: Direct through the Social Security Administration’s secure environment.
•
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.
•
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.
•
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), the Department of Justice (DOJ) and other authorized government users, for their use in
managing, tracking and reporting aviation related security events.
•
Providing information about airmen to Federal, State, local, and Tribal law enforcement, national security or homeland security agencies
whenever such agencies are engaged in the performance of threat assessments affecting the safety of transportation or national security.
The Department has also published 15 general routine uses applicable to all DOT Privacy Act systems of records. These routine uses are published in the
Federal Register at 84 FR 55222 - October 15, 2019, 77 FR 42796 - July 20, 2012, and 75 FR 82132 – December 29, 2010 and under “Privacy Act System
of Records Notices” (available at https://www.transportation.gov/individuals/privacy/privacy-act-system-records-notices).
Disclosure: Submission of all requested data is voluntary; however, failure to provide all the required information would result in the FAA’s inability to
issue a certificate and/or rating.

FAA Form 8610-2 (XX-22) SUPERSEDES PREVIOUS EDITION
Detach this supplemental information before using the attached form
ii

FAA Form 8610-2, Airman Certificate and/or Rating Application – Mechanic and
Parachute Rigger (14 CFR Part 65),
Supplemental Information
Your signature on FAA Form 8610-2 acknowledges that you received the Pilot’s Bill of Rights
Written Notification of Investigation at the time of your application.
PILOT’S BILL OF RIGHTS WRITTEN NOTIFICATION OF INVESTIGATION
The information you submit on the attached FAA form 8610-2, Airman Certificate and/or Rating
Application-Mechanic and Parachute Rigger (14 CFR Part 65), 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, 63, or 65.

•

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 the date this application was made is available to
you upon your written request addressed to:
Federal Aviation Administration
Airman Certification Branch
P.O. Box 25082
Oklahoma City, OK 73125-0082
If you make a written request for your airman application file, please provide the
following information in your request:
• Full legal name
• Date of birth or airman certificate number
• Date of the application

FAA Form 8610-2 (XX-22) SUPERSEDES PREVIOUS EDITION
Detach this supplemental information before using the attached form
iii

FAA Form 8610-2, Airman Certificate and/or Rating Application – Mechanic and
Parachute Rigger (14 CFR Part 65),
Supplemental Information
Instructions for Completing FAA Form 8610-2
GENERAL INFORMATION
•
An electronic, fillable, printable version of FAA Form 8610-2 is available at www.faa.gov.
•
Make all entries using permanent dark blue or black ink, or a typewriter or printer. All signatures must be original, with the name printed or typewritten
below or beside the signature.
•
Complete two (2) originals of FAA Form 8610-2 when submitting a printed application.
•
Unless otherwise specified, enter all dates using eight-digit numeric characters, MM/DD/YYYY (e.g., 03/29/2019).
•
Read all supplemental information provided with this form including the Paperwork Reduction Act Burden statement, the Privacy Act statement, the Pilot’s
Bill of Rights Written Notification of Investigation, and the Instructions for Completing FAA Form 8610-2. Remove and retain the supplemental information
before submitting the application.
IMPORTANT NOTE: The applicant’s signature on FAA Form 8610-2 confirms the applicant has received the Privacy Act statement and the Pilot’s Bill of Rights
Written Notification of Investigation at the time application was made.
All applications must have the application TOP Section, Section I. APPLICANT INFORMATION and Section IV. APPLICANT’S CERTIFICATION completed. See the
instructions below to determine the additional sections/blocks to be completed depending on the certificate requested and the basis for certification.

Page 1 - TOP Section
Original Issuance, Added Rating, Other. Mark the appropriate box to
indicate the reason application is being made. Mark the “Added Rating” box
only if you already have an airman certificate and are adding a rating to that
certificate. Mark “Other” if you are making application due to a change of
address, name, gender, citizenship, nationality, date of birth, or other
change, and enter the type of change requested.
Certificate Type and Ratings. Mark the appropriate box for the certificate
type and the rating(s) being applied for. Apply for only one certificate type
per application. Line through (cross out) ratings not applied for unless you
currently hold that rating.
Section I. APPLICANT INFORMATION
A. Name. Enter your full legal name. Use commas to separate names, i.e.
Last, First, Middle. If your full legal name is more than 47 characters
including the suffix and spaces, use no more than one middle name for
record purposes. Do not change your name on subsequent applications
unless it is done in accordance with 14 CFR § 65.16.
If you have a middle initial only, enter the initial. If you do not have a middle
name or middle initial, enter “NMN” (no middle name).
Indicate if you are a Jr., II, or III, etc.
B. Date of Birth. Enter your date of birth in the MM/DD/YYYY format.
C. Place of Birth. If you were born in the USA, enter the city and state where
you were born. If the city is unknown, enter the county and state. If you
were born outside the USA, enter the name of the city and country, or
province and country, of where you were born.
D. Height. Enter your height in inches. Example: 5’8” is entered as 68 in. No
fractions, use whole inches only.
E. Weight. Enter your weight in pounds. No fractions, use whole pounds
only.
F. Hair Color. Spell out the color of your hair. Choose from the following:
bald, black, blond, brown, gray, red or white. If you wear a wig or toupee,
enter the color of your hair under the wig or toupee.
G. Eye Color. Spell out the color of your eyes. Choose from the following:
black, blue, brown, gray, green, or hazel.
H. Sex. Mark either Male or Female.

I. Citizenship/Nationality. Mark the box for USA if you are a U.S. Citizen or
legally naturalized U.S. Citizen. Otherwise, mark “Other” and enter the
country where you are a legal citizen. Only show one citizenship reference
in Block I. Annotate dual citizenship countries in the REMARKS section.
Note: To claim Dual Citizenship, you must present appropriate citizenship
documentation for each country upon application.

J1. Physical Location/Address. Enter your complete residential address
including street number, city, state, and ZIP code. This block cannot be left
blank. If you have a foreign address, the country must be stated.
If a residential address does not exist, such as when the applicant resides
on a rural route, a boat, or some other manner that requires the use of a
P.O. Box, rural route, or personal mailbox, a map or written directions to
your physical address, 911 address, or Global Positioning System (GPS)
coordinates must be attached to the application or entered in the
Remarks block. Mark box for attached directions, if applicable.
A map or written directions are not required for Army Post Office
(APO)/Fleet Post Office (FPO)/Diplomatic Post Office (DPO) type
addresses.
J2. Mailing Address. Enter your mailing address, if different from block J1.
This address will be printed on the permanent airman certificate.
You may leave the block blank if the “Same as J1” box is marked. A post
office box, rural route, personal mailbox, commercial, or other mail drop
can be used as your preferred mailing address.
To have your airman certificate mailed to an address other than what is
listed in blocks J1 or J2, provide mailing instructions on a separate
attachment or in the remarks section of the form.
K. Other FAA Airman Certificate? Mark yes or no. If yes, state the
certificate type and number. Types of certificates include: pilot, mechanic,
repairman, etc. A student pilot certificate is a pilot certificate.
L. Have you ever had a certificate suspended or revoked? Mark yes or no.
If “YES” is marked, refer to §§ 65.11(c) and (d).
M. Do you read, write, speak and understand the English language. Mark
yes or no. Refer to § 65.71 and § 65.113(a)(2).
N. Drugs or substance conviction? Mark yes or no. Only mark yes if you
have actually been convicted. If yes is marked, include the date of final
conviction. Refer to § 65.12 and § 91.19(a).

FAA Form 8610-2 (XX-22) SUPERSEDES PREVIOUS EDITION
Detach this supplemental information before using the attached form
iv

FAA Form 8610-2, Airman Certificate and/or Rating Application – Mechanic and
Parachute Rigger (14 CFR Part 65),
Supplemental Information
Instructions for Completing FAA Form 8610-2, continued

II. APPLICATION BASIS
A. Mechanic - Civil Experience. Mark this box when applying for a Mechanic
certificate based on civil experience in accordance with § 65.77. If you gained
practical experience in both civil activity and military activity, mark both item A
and item B. Enter your experience in Section III.

E. Parachute Rigger. Instructions continued from previous column.
E2. Packed as a. Master parachute rigger applicants must mark the
appropriate box(es) to indicate if any of the parachutes were packed as a
senior rigger and/or military rigger.

III. RECORD OF EXPERIENCE
Columns 1 through 4. Enter your work experience related to the certificate
and rating being applied for. Must be completed by Civil or Military Mechanic
applicants and Master Parachute Rigger applicants. Continue additional
information on a separate sheet if necessary. Mark the box if you have
attached a separate sheet showing additional experience.
Note: Mechanic applicants should provide dates of experience in the eightdigit (MM/DD/YYYY) numeric format if necessary to count the days to
ensure eligibility based on 18 or 30 months of practical experience, as
applicable. Dates can be handwritten in columns 1 and 2, or annotated in
the Remarks block.
1. Date From. Enter your employment start date in a six-digit (MM/YYYY)
numeric character format.
2. Date To. Enter your employment end date in a six-digit (MM/YYYY)
numeric character format.
3. Employer and Location. Enter the name of your employer and the city
and state of your employment.
4. Type of Work Performed. Enter the type of work performed with the
employer, related to the certificate and rating requested. Job titles are not a
description of the type of work performed.
C. Mechanic - Graduate of an Approved Course. Mark this box when applying
IV. APPLICANT’S CERTIFICATION (page 1)
for a Mechanic certificate based on graduation from a 14 CFR part 147 Aviation
Applicants
Signature. Sign your name.
Maintenance Technician School (AMTS) FAA-Approved curriculum, including §
Date. Enter the date you signed the form, using the MM/DD/YYYY format.
65.80 applicants. Complete blocks C1 through C9 as applicable.
V. FAA Endorsement. Block is for FAA Use only.
C1. Select Basis. Mark the appropriate box to indicate the basis of application
for graduates of an approved course.
Note: FAA endorsement for testing is required for applicants applying
C2. AMTS Certificate Number. Enter the certificate number of the AMTS from
based on civil or military experience. AMTS and JSAMTCC graduates do
which you graduated.
not need FAA endorsement to test.
C3. AMTS Name. Enter the name of the AMTS from which you graduated.
PAGE 2
C4. AMTS Location. Enter the location (city and state) of the AMTS from which APPLICANT INFORMATION. When the application is printed on 2 separate
you graduated.
pages (i.e. not printed double-sided), enter your name, date of birth, and your
certificate number relating to this application. Leave the certificate number
C5. Curriculum. Mark the appropriate box for the curriculum from which
blank if this is an application for original issuance.
completed/graduated, as stated on the certificate. For § 65.80 applicants,
mark the box for the curriculum you are currently enrolled in. Only mark
Note: This ensures page 2 of the application is placed with the correct
“Airframe and Powerplant” if you have a single certificate showing
applicant on page 1 if the pages become separated.
graduation/completion of a combined airframe and powerplant curriculum. If REMARKS. You may annotate attachments, dual citizenship, mailing, or other
applying for both ratings, but have graduated from separate curriculums and
information related to the application, in this block. This block is also used by
have separate completion certificates, mark both the airframe and the
the FAA for annotating additional information regarding the application.
powerplant box.
APPLICANT’S CERTIFICATION (Page 2). Only complete this section at the time
C6. Graduation Date. Enter the date of AMTS graduation as shown on the
of issuance of a temporary certificate.
graduation certificate or certificate of completion. Enter dates using the
A. Certificate suspended or revoked? Mark yes or no. If “YES” is marked,
MM/DD/YYYY format. If applying for both ratings, but have graduated from
refer to § 65.11(c) and (d).
separate curriculums with separate completion certificates, enter the
B. Drug or Substance Conviction? Mark yes or no. Only mark yes if you have
additional graduation date in the Remarks block on page 2.
actually been convicted. If yes is marked, include the date of final conviction.
For § 65.80 applicants, enter the date you will graduate.
Refer to § 65.12 and § 91.19(a)..
C7. § 65.80 – Student Progress. An authorized AMTS official marks this block
Applicant Signature. Sign your name.
to indicate that the student meets the requirements to test under § 65.80.
Date. Enter the date you sign the application, using the MM/DD/YYYY format.
C8. School Officials Signature. The authorizing AMTS official must enter their
signature above or beside their typed or printed name to indicate the student ATTACHMENTS. Mark appropriate box(s) indicating attachments to the
application. Select “Other” when attachments are not listed in this block, and
meets AMTS requirements for testing under § 65.80.
C9. Date. The authorizing AMTS official must enter the date they sign block C8. annotate the attachment(s) in the Remarks block.
B. Mechanic - Military Experience. Mark this box when applying for a Mechanic
certificate based on military experience. Enter your experience in Section III. All
military applicants must complete blocks B1 - B3. Only JSAMTCC applicants
complete blocks B4 - B6.
B1. Military Service. If you gained all or part of the required experience in the
military, enter the branch of service in which you gained your experience.
B2. Military Rank or Grade. If you gained all or part of the required experience
in the military, enter the highest rank or pay level you obtained.
B3. Military Specialty Code(s). If you gained all or part of the required
experience in the military, enter the military specialty code(s) (or equivalent,
depending on the applicable branch of service) in which your experience was
gained.
B4. JSAMTCC Curriculum Completion. If you completed the JSAMTCC program,
mark the box of the corresponding JSAMTCC curriculum that was completed.
B5. Completion Date. Enter the date you completed the JSAMTCC program, as
shown on the JSAMTCC completion certificate.
B6. JSAMTCC Certificate Control No. Enter the certificate control number as
shown on the JSAMTCC Certificate of Eligibility.

D. § 65.80 – Special Authorization. These blocks are for FAA use only.
E. Parachute Rigger. Mark this box when applying for a Parachute Rigger
Certificate. For Master Parachute Rigger applicants only, enter your experience in
Section III.
E1. Number of Parachutes Packed. Indicate the number of parachutes packed
of each type.

APPLICANT IDENTIFICATION (ID). This is completed by the person verifying
your identity at the time of application or testing, and confirmed at
certificate issuance. Changes or corrections can be annotated in the Remarks
block.
If the applicant does not have a telephone number or email address, or
chooses not to provide this information, enter “NONE” in the block.

FAA Form 8610-2 (XX-22) SUPERSEDES PREVIOUS EDITION
Detach this supplemental information before using the attached form
v

OMB Control Number: 2120-0022
Expiration Date: 03/31/2025

TYPE OR PRINT ALL ENTRIES IN DARK INK

Airman Certificate and/or Rating Application – Mechanic and Parachute Rigger
(14 CFR Part 65)

☐ MECHANIC
☐Airframe
☐Powerplant

☐ORIGINAL ISSUANCE
☐ADDED RATING
☐OTHER ___________________

☐ PARACHUTE RIGGER
☐SENIOR
☐MASTER

I. APPLICANT INFORMATION
A. Name (Last, First, Middle)

D. Height (Inches)

☐Seat ☐Chest
☐Back ☐Lap

B. Date of Birth (MM/DD/YYYY)

E. Weight (Pounds)

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

F. Hair Color (spell out) G. Eye Color (spell out)

H. Sex ☐ Male

J2. Mailing Address (Will show on certificate)

K. Do you now hold or have you ever held an FAA airman certificate? ☐ No

I. Citizenship / Nationality ☐ USA

☐ Female
J1. Physical Location/Address (Required)
☐Directions are attached.

☐Same as J1.

☐ Other: __________________________________

☐ Yes, Certificate type and number: ____________________________
L. Have you ever had an FAA airman certificate suspended
☐ No ☐ Yes
or revoked?
M. Do you read, write, speak, and understand the English
☐ No ☐ Yes
language?

N. Have you ever been convicted for violation of any Federal or State statutes relating to narcotic drugs, marijuana, depressant or stimulant drugs or substances?
Refer to § 65.12 and § 91.19(a)
☐No
☐Yes, Date of Final Conviction (MM/DD/YYYY): ____________________________
II. APPLICATION BASIS Complete Section III, Record of Experience, when application basis is A, B or E (Master Rigger only) below.
☐ A. MECHANIC - CIVIL EXPERIENCE
☐ B. MECHANIC - MILITARY EXPERIENCE B1. Military Service (Branch):

B2. Military Rank/Grade:

B4. JSAMTCC Curriculum Completed: ☐ Airframe ☐ Powerplant ☐ Airframe & Powerplant

C2. AMTS Certificate Number

C3. AMTS Name

C5. AMTS Curriculum Graduated:

C7. ☐ The AMTS affirms that this student has made
satisfactory progress and is recommended to take the
Oral/Practical test under 14 CFR part 65.80.

☐ D. § 65.80 – Special authorization to

take Mechanic’s Oral/Practical test.
☐ E. PARACHUTE RIGGER

☐ Powerplant

☐ Airframe & Powerplant

MM/DD/YYYY

Chest ____

Back ____

Lap ____

III. RECORD OF EXPERIENCE Continue additional information on a separate sheet if necessary.
1. DATE FROM (MM/YYYY) 2. DATE TO (MM/YYYY)

(Proposed date if § 65.80)

C9. Date (MM/DD/YYYY)

D4. FAA Office/Desig. No.

(Print Name and Sign)

E2. Packed as a: (For Master Parachute Rigger Only)

E1. Number of Parachutes Packed
Seat ____

C6. Graduation Date (MM/DD/YYYY)

C8. School Officials Signature (For § 65.80 authorization only) (Print Name and Sign)

D1. Date Authorized D2. Date Auth. Expires D3. FAA Signature

(MM/DD/YYYY)

☐AMTS § 65.80 APPLICANT

C4. AMTS Location (City, State)

☐ Airframe

(or Curriculum enrolled if § 65.80)

B6. JSAMTCC Certificate
Control No.

(MM/DD/YYYY)

C1. Select Basis: ☐AMTS GRADUATE

☐ C. MECHANIC – GRADUATE OF AN APPROVED COURSE

B3. Military Specialty Code(s):

B5. Completion Date

3. EMPLOYER AND LOCATION (Employer Name, City, State)

☐ Military Parachute Rigger

☐ Senior Parachute Rigger

☐ Mark this box if separate sheet attached for additional experience.
4. TYPE OF WORK PERFORMED (Describe work performed, not job title)

IV. APPLICANT’S CERTIFICATION This area is completed by the applicant at the time application is made.
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.
Applicant’s Signature

Date (MM/DD/YYYY)

V. FAA ENDORSEMENT: I find this applicant meets the experience requirements of 14 CFR part 65 and is eligible to take the required tests.
FAA Signature (Print Name and Sign)

FAA Form 8610-2 (XX-22) SUPERSEDES PREVIOUS EDITION

Date (MM/DD/YYYY)

FAA Office/Designation No.

Page 1 of 2

APPLICANT INFORMATION (Required if application is printed on 2 pages)
Name (as shown on page 1 of application):

Mechanic

Date of Birth (MM/DD/YYYY):

RESULTS OF ORAL AND PRACTICAL TESTS (For FAA Use Only)

I. GENERAL
Oral Test

Parachute Rigger

SEAT
☐ PASS

EXPIRATION DATE:

☐ FAIL

TYPE

Question
Number

Practical Test

Certificate Number (if any):

☐ PASS

EXPIRATION DATE:

BACK

☐ PASS

☐ FAIL

☐ PASS

☐ FAIL

LAP

☐ PASS

☐ FAIL

PARACHUTE SEAL SYMBOL ASSIGNED:

II. AIRFRAME STRUCTURES
Oral Test

☐ FAIL

CHEST

☐ FAIL

Project
Number

☐ PASS

REMARKS

☐ PASS

EXPIRATION DATE:

☐ FAIL

☐ PASS

EXPIRATION DATE:

☐ FAIL

Question
Number

Practical Test
Project
Number

III. AIRFRAME SYSTEMS AND COMPONENTS
Oral Test

☐ PASS

EXPIRATION DATE:

☐ FAIL

☐ PASS

EXPIRATION DATE:

☐ FAIL

Question
Number

Practical Test
Project
Number

IV. POWERPLANT THEORY AND MAINTENANCE
Oral Test

☐ PASS

EXPIRATION DATE:

☐ FAIL

☐ PASS

EXPIRATION DATE:

☐ FAIL

Question
Number

Practical Test
Project
Number

V. POWERPLANT SYSTEMS AND COMPONENTS
Oral Test

☐ PASS

EXPIRATION DATE:

☐ FAIL

☐ PASS

EXPIRATION DATE:

☐ FAIL

Question
Number

Practical Test
Project
Number

APPLICANT’S CERTIFICATION This area is completed by the applicant at the time of issuance of the temporary airman certificate (FAA Form 8060-4).
A. Have you ever had an FAA airman certificate suspended or revoked?

☐ NO

☐ YES

B. Have you ever been convicted for violation of any Federal or state statues relating to narcotic
drugs, marijuana, or depressant or stimulant drugs or substances?

☐ NO
☐ YES, Date of Final Conviction: __________________________
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 a 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.
Applicant’s Signature
Date (MM/DD/YYYY)
FAA EXAMINER’S REPORT
I have tested this applicant in accordance with pertinent procedures and standards and I have indicated the result as:
☐ APPROVED (Temporary Certificate Issued)
☐ APPROVED (Temporary Certificate NOT Issued) ☐ 14 CFR § 65.80 – Oral/Practical PASSED
FAA Signature (Print Name and Sign)
I have examined this applicant’s papers and I have indicated the result as:
FAA Signature (Print Name and Sign)
ATTACHMENTS

FAA Office/Designation No.

☐ APPROVED (Temporary Certificate Issued)
Date (MM/DD/YYYY)

FAA Office/Designation No.

APPLICANT IDENTIFICATION (ID) (Government Issued Photo ID)

☐ Knowledge Test Report(s)

☐ Temporary Certificate

Form of ID

☐ Test Planning Sheet

☐ Statement of Additional
Instruction

ID Number

☐ Other see Remarks block

Telephone No

☐ Graduation/Completion
Certificate

☐ DISAPPROVED

Date (MM/DD/YYYY)

FAA FILE REVIEW (For FAA Office Use Only)
FAA Signature
(Print Name and Sign)

FAA Form 8610-2 (XX-22) SUPERSEDES PREVIOUS EDITION

State or Country
Expiration Date
Email Address

Date (MM/DD/YYYY)

FAA Office
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