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AVIATION SAFETY INSPECTOR (MANUFACTURING) Supplemental Questionnaire

NAME: ________________________________________ SSN: ________________________________________

DATE: ____________________

Please circle the correct response and provide the information requested. This information will be used to determine your eligibility for Aviation Safety Inspector (Manufacturing) positions.

1. I currently possess a valid state driver's license. 2. I am able to communicate orally and in writing in the English language. 3. I am a high school graduate, or I have an equivalency certificate. 4. I have not had more than 2 separate incidents involving Federal Aviation Regulations violations in the last 5 years. 5. Circle your highest level of education. a. No degree c. Bachelor's degree b. Associate degree d. Master's/Doctorate degree

Yes Yes

No No

Yes

No

Yes

No

6. I have a valid FAA mechanic certificate with airframe and powerplant ratings. 7. I have a current private pilot certificate or higher pilot certificate. 8. I have been employed by the FAA as an Aviation Safety Inspector. 9. I have more than 10 years experience in the aviation field. 10. I have manufacturing work experience in both general aviation and air carrier aircraft. 11. I have work experience in both the operations and maintenance fields. 12. I have aviation investigative experience; e.g., field representative for an aircraft manufacturer, aircraft accident investigator, or legal investigator. 13. Circle the number of years of work experience you have in establishing and/or implementing quality planning/inspection systems. a. None c. 5-9 years b. 0-4 years d. 10 or more years

Yes

No

Yes

No

Yes

No

Yes Yes

No No

Yes

No

Yes

No

ASI-Mfg-001 (3/99) Page 1 of 3

14. I have work experience as a quality supervisor/manager at a facility which produces FAA-approved complete aircraft, propellers, or class II products. 15. I have been involved in activities related to FAA type certificate (TC) and/or supplemental type certificate (STC) programs/projects or production approval programs. 16. I have work experience as a designated manufacturing inspection representative (DMIR). If yes, list the issuing MIDO location: ______________________________ FAA DMIR No.: ______________________________ Date Issued: ______________________________.

Yes

No

Yes

No

Yes

No

17. I have work experience as a designated airworthiness representative (DAR) in manufacturing. If yes, list the issuing MIDO location: ______________________________ FAA DAR No.: ______________________________ Date Issued: ______________________________.

Yes

No

18. I have work experience as a delegation option authorization (DOA) inspector. If yes, list the Name of company: ______________________________ Assigned DOA No.: ______________________________ Date Issued: ______________________________.

Yes

No

19. I have work experience with software quality assurance systems. 20. I have work experience with quality control for composite materials/structures. 21. I have work experience with non-destructive inspection (NDI) techniques. 22. I have work experience as a quality inspector on the flight line at a facility which produces FAA type certificated products. 23. I have work experience with statistical process control (SPC) applications. 24. I have been employed as a certificated mechanic or repairman directly in charge of maintenance at a manufacturer's maintenance facility (MMF). 25. I have work experience in technical writing. 26. I have work experience with computer-aided manufacturing/inspection systems or equipment. 27. I have work experience with the manufacture of navigation or flight management systems. 28. I have work experience in auditing procurement quality systems.

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes Yes

No No

Yes

No

Yes

No

ASI-Mfg-001 (3/99) Page 2 of 3

GEOGRAPHIC CODE LIST Please select up to 9 geographic areas where you would like to be considered for employment. You will only be referred for employment consideration for the geographic areas you select. You may select from the list of regions and/or Manufacturing Inspection District Offices (MIDO's) below. If you select region(s), you may be referred for all locations within the region(s). If you mark more than 9 choices, only the first 9 will be considered. Central Region Wichita, KS Kansas City, MO Eastern Region Tetersboro, NJ Farmingdale, NY New Cumberland, PA Great Lakes Region Chicago, IL Detroit, MI Minneapolis, MN Cleveland, OH Vandalia, OH New England Region Windsor Locks, CT Burlington, MA Northwest Mountain Region Auburn, WA Everett, WA Lynwood, WA Renton, WA Seattle, WA Southern Region Mobile, AL Orlando, FL Atlanta, GA Savannah, GA Southwest Region Bethany, OK Fort Worth, TX San Antonio, TX Western-Pacific Region Phoenix, AZ Long Beach, CA Los Angeles, CA Van Nuys, CA

PRIVACY ACT AND PUBLIC BURDEN STATEMENT

Public Law 104-50 allows the Federal Aviation Administration (FAA) to rate applicants for employment. We need the information on this application questionnaire to see how well your education and work skills qualify you for employment with the FAA. We also need information on matters such as citizenship and military service to see whether you are affected by laws we must follow in deciding whom the Federal government may employ. Executive Order 9397 authorizes the solicitation of your Social Security Number (SSN) for use as an identifier in personnel records management to assure proper identification of applicants throughout the selection and employment process. The information we collect on this questionnaire, including your SSN, will be used for employment purposes, and it may also be used for statistical studies or computer matching with other government files. Furnishing your SSN or any of the other information requested in the vacancy announcement is voluntary; however, failure to provide this information will prevent the processing of your application and will prevent your consideration for employment. The nature of the information received is confidential, and authorized officials will handle it appropriately. This information becomes part of a Privacy Act System of Records as identified in 5CFR 552a, under OPM/GOVT-1: General Personnel Records. We estimate it will take you 30 minutes or less to complete this form, including the time required to read the instructions, provide the requested information, and review your responses. Send comments regarding this estimate or any other aspect of the collection of information, including suggestions for reducing the burden, to the Federal Aviation Administration, Assistant Administrator for Human Resource Management, 800 Independence Avenue, SW, Washington, D.C. 20591.

ASI-Mfg-001 (3/99) Page 3 of 3