Free Rotorcraft External Load Certificate Application - Federal

US Department of Transportation Federal Aviation Administration

ROTORCRAFT EXTERNAL-LOAD OPERATOR CERTIFICATE APPLICATION
Paperwork Reduction Act Statement: The information collected on this form is solicited in order to comply with Title 14, Code of Federal Regulations, Part 133. This information is used to establish eligibility for the issuance of the Rotorcraft External-Load Operator Certificate. Confidentiality is neither requested nor provided. We estimate that it will take approximately 0.3 hours to complete the 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 connection is 2120-0044. 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

TEAR OFF BEFORE USE
FAA Form 8710-4
(6-84) THIS PART SUPERSEDES FAA FORM 8000-32
Electronic Version (Adobe)

SUPPLEMENTAL INFORMATION
DETACH THIS PART BEFORE USING FORM BELOW

Form Approved: OMB No. 2120-0044 09/30/2008
US Department of Transportation

Federal Aviation Administration

Rotorcraft External-Load Operator Certificate Application

INSTRUCTIONS: Submit this form in triplicate to local FAA District Office 1. APPLICATION FOR (CHECK APPLICABLE BOX) ORIGINAL ISSUANCE AMENDMENT RENEWAL 2. NAME AND ADDRESS OF APPLICANT (Include Zip Code) CERTIFICATE NO. (For amendment or renewal only.) EXTERNAL - LOAD CLASS AUTHORIZATION (S) A B C

3. PRINCIPAL OR LOCAL BASE OF OPERATIONS (Airport, City, State, and Zip Code)

TELEPHONE NUMBER TELEPHONE NUMBER 4. NAME OF CHIEF PILOT OR PILOT IN CHARGE OF LOCAL OPERATION

AIRMAN CERTIFICATE
ATTACH PREV

GRADE

NUMBER

5. REGISTRATION NUMBER TYPE MAKE MODEL

ROTORCRAFT TO BE USED LOAD CLASS (X) A B C
DEVICE APPD.

REMARKS

YES

NO

CERTIFICATION

I certify that the statements made on this application form and any attachments are true and correct, and that the operations indicated on this application will be conducted within the requirements of the Federal Aviation Act of 1958 and the applicable Federal Aviation Regulations.
DATE TITLE OF AUTHORIZED OFFICER SIGNATURE OF APPLICANT OR AUTHORIZED OFFICER

FAA Form 8710-4

(6-84)

SUPERSEDES FAA FORM 8420-7 and FAA FORM 8000-32

Electronic Version (Adobe)

INSPECTION REPORT
(To be completed by FAA District Office Representative) ROTORCRAFT MAKE MODEL REGISTRATION NUMBER APPROVAL DATE CLASS WEIGHT AUTHORIZED LIMITATIONS AND REMARKS INSPECTOR'S SIGNATURE

REMARKS

CHIEF PILOT KNOWLEDGE AND SKILL REQUIREMENTS MET BY: NAME OF CHIEF PILOT

CLASS A CLASS B CLASS C

DATE

SIGNATURE OF INSPECTOR

Applicant is Fully Qualified to Conduct External - Load Operations in Class (es) CLASS A APPLICATION DISAPPROVED CLASS B REASONS: CLASS C

CERTIFICATE NUMBER

ISSUED ON

FAA DISTRICT OFFICE

SIGNATURE OF SUPERVISING INSPECTOR

Electronic Version (Adobe)