FAA Form 8710 1

User Manual: 8710

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FAA Form 8710-1, Airman Certificate
and/or Rating Application
Supplemental Information and
Instructions
Paperwork Reduction Act Statement
The information collected on this form is necessary to determine applicant eligibility for airman ratings. We estimate it will take 30
minutes to complete this form. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number. The OMB control number associated with this
collection is 2120-0021, and its expiration date is August 31, 2019. Comments concerning the accuracy of this burden and suggestions
for reducing the burden should be directed to the FAA at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information
Collection Clearance Officer, ASP-110.
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 certificate number;
• 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 secure environment.
(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 certification decision.
(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 security events.
(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 written request
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
AIRMAN CERTIFICATE AND/OR RATING APPLICATION
INSTRUCTIONS FOR COMPLETING FAA FORM 8710-1
I.
APPLICATION INFORMATION. Mark “X” in all appropriate blocks(s).
Note: Please enter all dates in eight digits as MM/DD/YYYY.
Use numeric characters, (e.g. 01/01/2014).
Block A. Name. Enter full legal name (Last, First, Middle). If your full legal name is
more than 50 characters, use no more than one middle name for record purposes. Do not
change the name on subsequent applications unless it is done in accordance with 14 CFR
part 61.25. If you do not have a middle name, enter “NMN.” If you have a middle
initial only, indicate “Initial only.” Indicate if you are a Jr., II, or III.
Block B. Social Security Number. Enter either your 9-digit social security
number, “Do Not Use” or “None” if you are not a U.S. citizen. If entering a social
security number, only enter a 9-digit U.S. social security number (optional). See
supplemental Privacy Act Information.
Block C. Date of Birth. Enter your date of birth in the following format:
MM/DD/YYYY. Check for accuracy. Verify that DOB is the same as it is on the
medical certificate.
Block D. 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 where you were born.
Block E1. Residential Address. Enter your complete residential address. This must
include street number, city, state, and zip code. If the applicant has a foreign address, the
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
numbers are not transposed.
Block E2. Mailing Address. Enter your mailing address, if different than block E1.
This may be a residence, post office box, rural route, flight school address, personal mail
box (PMB), commercial address, or other mail drop location, as applicable. The address
provided in block E2, if any, will be printed on the permanent airman certificate. If you
want your airman certificate mailed to an address other than provided in blocks E1 or E2,
you will need to provide instructions on a separate attachment or in the remarks section
of the form.
Block F. Citizenship/Nationality. Mark USA if you are a U.S. Citizen or
legally naturalized U.S. Citizen. If you are not a U.S. citizen, mark “Other” and enter
the country where you are a legal citizen. To claim Dual Citizenship the applicant
must present appropriate documentation of citizenship for each country.
Block G. Do you read, speak, write and understand the English language?
Mark yes or no. If you answered “No” and it is due to medical reasons, an operating
limitation will be placed on the airman certificate.
Block H. Height. Enter your height in inches. Example: 5’8” would be entered as
68 in. No fractions, use whole inches only.
Block I. Weight. Enter your weight in pounds. No fractions, use whole pounds
only.
Block J. 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.
Block K. Eye Color. Spell out the color of your eyes. Choose from the following:
black, blue, brown, gray, green, or hazel.
Block L. Sex. Mark either Male or Female as appropriate.
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 M3. Date Issued. Enter the date your pilot certificate was last issued.
Block N. Do You Hold, or Have You Ever Held a Medical Certificate? Mark
applicable boxes. If yes, complete blocks N1, N2, and N3.
Block N1. Class of Medical Certificate. Enter the class as shown on the
medical certificate, (i.e., First, Second, or Third Class). If your most recent medical
certificate which was valid at some point after July 14th, 2006 has expired and you are
operating under BasicMed, enter “BASICMED” in this field.
Block N2. Name of Medical Examiner. Enter the medical examiner’s name
as shown on your medical certificate. If you are operating under BasicMed, leave
blank.
Block N3. Date Issued. Enter the date your medical certificate was issued. If you are
operating under BasicMed, leave blank.
Block O. Narcotics Drugs. Mark appropriate block. Only mark “Yes” if you
have actually been convicted. If you have been charged with a violation which has not
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
application.
Block O1. Date of Final Conviction. If block “N” was marked “Yes” provide
the date of final conviction.
II.
CERTIFICATE OR RATING APPLIED FOR ON BASIS OF: Block
A. Completion of Required Test.
1. Aircraft to be used. (If flight test required) – Enter the make and model of each
aircraft used or represented. If a flight simulation training device (FSTD) is used,
indicate Level of Device(s).
2. Total time in this aircraft and/or approved full flight simulator (FFS) or flight
training device (FTD) (Hrs.) – (2a) Enter the total Flight Time (2b) Enter Pilot-In-
Command (PIC) Flight Time.
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,
enter the make and model of each military manned aircraft used to qualify (as
appropriate). ATD, FTD, or FFS time cannot be used.
Block C. Graduate of an Approved Course.
1. Name, Location, Certification Number of Training Agency/Center, as shown on the
graduation certificate. Indicate if this was a part 142 training center.
2. Curriculum From Which Graduated. Enter name of curriculum and level,
category, and/or type rating, as applicable.
3. Date. Date of graduation from indicated course.
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
Training Center.
Block D. Holder of Foreign License.
1. Country that Issued the Foreign Pilot License.
2. Grade Of Foreign Pilot License (i.e. private, commercial, etc).
3. Number. Number which appears on the foreign license.
4. Ratings. Enter the FAA equivalent only ratings that appear on the foreign license.
Indicate the ratings as they will appear on the FAA Certificate (i.e. ASEL, AMEL,
ROTORCRAFT HELICOPTER, CE-500, etc).
Block E. Completion of Air Carrier’s Training Program.
1. Name of air carrier.
2. Date program was started.
3. Identify the training program accomplished.
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? Mark “Yes” or “No” as
appropriate.
V.
APPLICANT’S CERTIFICATION.
A. Signature. Sign your name.
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 08/31/2019
Page 1 of 2
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:
Instrument:
Ground Instructor:
Initial
Renewal
Reinstatement
Reexamination
Reissuance
Flight Review
Instrument Proficiency Check
Medical Flight Test
Limitation Removal
Student
Private
ATP-Restricted
Recreational
Commercial
ATP
Flight
Ground
ASE
AME
Land
Sea
Airplane
Basic
Helicopter
Balloon
Glider
Helicopter
Advanced
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
MM/DD/YYYY
D. Place of Birth
(City and State) or (City and Country)
E1. Residential Address
(Including City, State, Zip Code, and Country)
E2. Mailing Address
(This address will be printed on the
permanent
airman certificate, if different than block E1.)
F. Citizenship / Nationality
USA Other
specify:
G. Do you read,
speak, write, &
understand the
English language?
Yes
No
H. Height
(inches)
I. Weight
(pounds)
J. Hair Color
K. Eye Color
L. Sex
Male
Female
M. Do you hold, or have you ever held an FAA pilot certificate?
Yes No
M1. Grade of Certificate
M2. Certificate Number
M3. Date Issued
N. Do you hold, or have you ever held a Medical Certificate?
Yes - FAA Yes - Foreign Yes - Military No
N1. Class of Certificate
N2. Name of Medical Examiner
N3. Date Issued
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
motor vehicle mode of transportation as those offenses are covered on the FAA Form 8500-8, Airman Medical Application Form. Yes No
O1. Date of Final Conviction
II. CERTIFICATE OR RATING APPLIED FOR ON BASIS OF:
A.
Completion of
Test or Activity
1. Aircraft to be used
(If flight test required)
2. Total time in this aircraft and/or
approved FFS or FTD (hours):
a. Flight
Time
b. As Pilot-in-
Command
B.
U.S. Military
Competence or
Experience
1. U.S. Military Service
2. Date Rated in U.S. Military
3. Rank or Grade
4. List Military aircraft
for which you have:
a. logged pilot time or provided flight instruction (IP)
(make and model)
b. passed an Instrument Proficiency Check
(Pilot or CFI) -
(make and model)
C.
Graduate of an
Approved
Course
1.Training Agency
or Training Center:
1a. Name
1b. Location
(City and State)
1c. Certification Number
1d. Part 142?
Yes No
2. Curriculum From Which Graduated
(Level, Category, and Class and/or Type Rating)
3. Date
D.
Holder of
Foreign
License
1. Country that Issued the Foreign Pilot License
2. Grade of Foreign Pilot License
3. Foreign Pilot License Number
4. Ratings Held on Foreign Pilot License
(FAA equivalent only – e.g. ASEL, AMEL, Type rating, etc.)
E.
Air Carrier
Training Program
1. Name of Air Carrier
2. Date Training Began
3. Accomplished Training Program
Initial Upgrade Transition Recurrent
III. RECORD OF PILOT TIME (Do not write in the shaded areas)
Total Instruction
Received Solo PIC
and
SIC
Cross Country
Instruction
Received
Cross Country
Solo Cross Country
PIC/SIC Instrument Night
Instruction
Received
Night
Take-Off /
Landing
Night
PIC/SIC
Night
Take-
Off/Landing
PIC/SIC
Number of
Flights Aero-Tows Ground
Launches Powered
Launches
Airplanes PIC PIC PIC PIC Gliders
SIC SIC SIC SIC
Lighter-than-
air
Rotorcraft
PIC PIC PIC PIC
Class Totals
SIC SIC SIC SIC
Airplane
SEL MEL SES MES
Powered
Lift
PIC PIC PIC PIC PIC PIC PIC PIC
SIC SIC SIC SIC SIC SIC SIC SIC
Gliders PIC
Rotorcraft
Helicopter
Gyroplane
SIC
Lighter-
Than
-Air
PIC PIC PIC PIC Lighter-than-
air
Balloon
Airship
SIC SIC SIC SIC
FFS FFS
SE
ME
Helicopter
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
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:
Certifying Statement
College Transcript (Official)
ATP CTP Graduation Certificate
Knowledge Test Report
Temporary Airman Certificate
Notice of Disapproval
Superseded Airman Certificate
Airman’s Identification (ID)
(US driver’s license or passport recommended) Applicant Information
(required if printed on 2 pages)
Form of ID
Name
ID Number (If issued by State, include State)
Date of Birth
Expiration Date (must be valid)
Certificate Number
Telephone Number
E-Mail Address
Meets Aviation English Language Standard Does Not Meet Aviation English Language Standard Referred to FSO for Aviation English Language
REMARKS: Standard Determination
FAA Form 8710-1 (10-17) Supersedes Previous Edition Page 2 of 2

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