DPRE Supplemental Information Sheet

DPRE SIS.docx

Representatives of the Administrator, 14 CFR part 183

DPRE Supplemental Information Sheet

OMB: 2120-0033

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DPRE SUPPLEMENTAL INFORMATION


This sample document, or a similar format may be used to provide supplemental information to support eligibility, and qualifications for appointment as a FAA Designated Parachute Rigger Examiner (DPRE).


Describe your experience that pertains to qualifications for a Designated Parachute Rigger Examiner (DPRE). Please be detailed in your responses in order to support your experience. Refer to FAA Order 8000.95 Designee Management System, Volume 5 for minimum experience requirements for a DPRE. You may attach additional experience pages as necessary.


Name of Employer/Organization:

Telephone Number:

Street Address:

City:

State (Country if other than USA):

Zip/Postal Code:

Job/Position Title:

Dates Employed:

From: ________________ To:___________________

Supervisor’s Name:

FAA Air Agency or Air Operator Certificate Number

(If applicable):

Experience (add additional pages if needed):


Name of Employer/Organization:

Telephone Number:

Street Address:

City:

State (Country if other than USA):

Zip/Postal Code:

Job/Position Title:

Dates Employed:

From: ________________ To:___________________

Supervisor’s Name:

FAA Air Agency or Air Operator Certificate Number

(If applicable):

Experience (add additional pages if needed):

Name of Employer/Organization:

Telephone Number:

Street Address:

City:

State (Country if other than USA):

Zip/Postal Code:

Job/Position Title:

Dates Employed:

From: ________________ To:___________________

Supervisor’s Name:

FAA Air Agency or Air Operator Certificate Number

(If applicable):

Experience (add additional pages if needed):

Name of Employer/Organization:

Telephone Number:

Street Address:

City:

State (Country if other than USA):

Zip/Postal Code:

Job/Position Title:

Dates Employed:

From: ________________ To:___________________

Supervisor’s Name:

FAA Air Agency or Air Operator Certificate Number

(If applicable):

Experience (add additional pages if needed):

Name of Employer/Organization:

Telephone Number:

Street Address:

City:

State (Country if other than USA):

Zip/Postal Code:

Job/Position Title:

Dates Employed:

From: ________________ To:___________________

Supervisor’s Name:

FAA Air Agency or Air Operator Certificate Number

(If applicable):

Experience (add additional pages if needed):

FAA Certificates Held


Provide the details of any FAA certificates held. For repairman certificates, also include the limitations stated on the certificate in the “RATINGS” column.


CERTIFICATE

TYPE

CERTIFICATE

NUMBER

RATINGS

DATE

OF ISSUANCE























Fixed Base of Operation

Address of applicant’s fixed base of operation equipped to support testing for parachute rigger certification.





File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleApplicant’s Name__________________________________________________
AuthorDOT/FAA
File Modified0000-00-00
File Created2024-10-28

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