Light-Sport Standardization Board-Designated Pilot Examiner Candidate Application {FAA 8710-12}

Form Approved OMB No. 2120-0690 07/31/2007 LIGHT-SPORT STANDARDIZATION BOARD--DESIGNATED PILOT EXAMINER CANDIDATE APPLICATION Supplemental Information and Instructions U.S. Department of Transportation Federal Aviation Administration Privacy Act Statement The information on the accompanying form is solicited under authority of the Public Law 103-272, dated July 5, 1994. The purpose of this information is to determine your eligibility for designation as a pilot examiner. The information will become part of the Privacy Act system of records DOT / FAA 830, Representatives of the Administrator, and will be used to evaluate your qualifications for designation as a pilot examiner. Submission of all data is mandatory except for Social Security Number (SSN), which is voluntary. If you do not disclose your SSN, a unique number will be assigned to your file. Your application cannot be processed unless the information is complete. Paperwork Reduction Act Statement The information is necessary to determine your eligibility to become a pilot examiner. It is estimated that it will take approximately 55 minutes per response. The information will become part of the Privacy Act system of records, DOT / FAA 830, Representatives of the Administrator, and it will be used to evaluate your qualifications for appointment as a designated pilot examiner. It should be noted that 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 of information is 2120-0690. 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, ABA-20 Detach all supplemental information and instruction sheets before submitting application. LIGHT-SPORT STANDARDIZATION BOARD -- DESIGNATED PILOT EXAMINER CANDIDATE APPLICATION HOW TO APPLY--(Initial Designations) · Answer all applicable questions (blocks) fully. · Refer to the attached instruction sheets if you require assistance to answer a question (block). · Complete, sign, and date this application in black ink. · If you need more space to answer a question (block), use additional sheets of blank paper. Be sure to indicate the question (block) number and your name at the top of each additional sheet. · Attach a copy (front and back) of all applicable pilot, flight instructor, and either an airman medical certificate or valid US Drivers License to this application. · Remove all instruction sheets before you send in your completed application. · Be sure to keep a completed copy of the application and all additional sheets for your files. WHERE TO SEND APPLICATION-- Federal Aviation Administration Light-Sport Aviation Branch (AFS-610), ATTN: Light-Sport Standardization Board, P.O. Box 25082, Oklahoma City, OK 73125-0082 WHAT HAPPENS TO YOUR APPLICATION-- The Light-Sport Standardization Board (LSSB) will evaluate your application to ensure that you meet the selection criteria for the designation(s) sought. The LSSB will advise you, in writing, whether or not you meet the applicable selection criteria. If the LSSB sends you a letter stating you do NOT meet the selection criteria, do NOT take the predesignation knowledge test. If the LSSB sends you a letter stating you do meet the selection criteria, you will be directed to take the examiner predesignation knowledge test appropriate to the designation(s) sought. For example: airplane, weight-shift control, gyroplane, glider, powered parachute, airship and balloon. You may take the examiner predesignation knowledge test at any FAA-approved computerized testing center. Request the pilot examiner predesignation knowledge test for the category applicable to the designation(s) sought. You MUST forward the original test results to the LSSB within 10 days of the date you take the examiner predesignation knowledge test. Keep a copy of the test results for your personal records. Upon receiving your original test results with a score of 80 percent or higher, the LSSB will notify you of approval or disapproval for assignment to the national examiner candidate pool. The LSSB will forward only the top three ranking candidates within the national examiner candidate pool to AFS-610 when they request a new designee. The LSSB keeps your application in the national examiner candidate pool for 2 years or until AFS 610 selects you, whichever comes first. After 2 years, the LSSB will delete the applications of all candidates not selected from the national examiner candidate pool. An applicant must repeat the application process in order to apply for reassignment to the national examiner candidate pool. FAA Form 8710-12 (9-04) i American LegalNet, Inc. www.FormsWorkflow.com Form Approved OMB No. 2120-0690 07/31/2007 LIGHT-SPORT STANDARDIZATION BOARD--DESIGNATED PILOT EXAMINER CANDIDATE APPLICATION Supplemental Information and Instructions (Continued) TYPES OF DESIGNATIONS AND DESIGNEE DEFINITIONS-- SPE - Sport Pilot Examiner SFIE - Sport Pilot Flight Instructor Examiner GENERAL QUALIFICATIONS-- · The applicant must hold all pertinent category and classes for each aircraft for which designation is sought. · The applicant must hold a valid third-class airman medical certificate or valid U. S. driver's license for initial designation. (A medical certificate or U. S. driver's license is NOT required for designations limited to examining in balloons and gliders.) · The applicant must be at least 21 years old. · The applicant must have a good record as a pilot and flight instructor with regard to accidents, incidents, and violations. · The applicant must meet all eligibility and experience requirements for the specific designation sought in accordance with the table on page iv and the appropriate FAA orders and handbooks. · The applicant must have a reputation for integrity and dependability in the industry and the community. · The applicant must have a history of a harmonious relationship with the FAA. INSTRUCTIONS FOR COMPLETING FAA FORM 8710-11-- 1. All entries on FAA Form 8710-11 must be made in black ink or typewritten. 2. Read the attached "Privacy Act Statement." 3. Complete blocks 1 through 33: a. Block 1. Name (Last, First, Middle)-- (1) Enter your legal name. For record purposes, do not use more than one middle name. (2) If you do not have a middle name, enter "NMN" (no midd