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Get FAA 8110-14 2011-2024

FAA Form 8110-14 Statement of Qualifications Organizations complete only the applicable blocks and attach separate resumes with the names signatures titles and qualifications of those persons who would actually perform the authorized functions. Form Approved OMB-2120-0033 Expiration Date 08-31-2013 3. U*S* CITIZEN STATEMENT OF QUALIFICATIONS DAR-DMIR-DER US Department of Transportation Federal Aviation Administration INSTRUCTIONS Print or type all entries except signatures Yes No 1. NAME Last first middle OR ORGANIZATION 4. DATE OF BIRTH 2. BUSINESS OR COMPANY ADDRESS Number street city state and ZIP code 5. BUSINESS PHONE NUMBER 6. BUSINESS FAX NUMBER 7. EMAIL ADDRESS 8. DESIGNATION SOUGHT Designated Engineering Representative DER Structural Engineering Engine Engineering Powerplant Engineering Propeller Engineering Company Systems and Equipment Engineering Flight Analyst Consultant Flight Test Pilot Acoustical Engineering Note Manufacturing Function s Designated Airworthiness Representative DAR A separate application must be submitted for each discipline i*e* Manufacturing or Engineering. Designated Manufacturing Inspection Representative DMIR Applicants shall identify specific function s for which appointment is sought 9. EXPERIENCE RESUME FOR NUMBER OF YEARS AS APPROPRIATE PERTINENT TO DESIGNATION SOUGHT. Use additional sheets if necessary Dates From To Employer s Name Position Title and Duties 10. EDUCATION AND TRAINING HIGH SCHOOL LEVEL AND ABOVE PERTINENT TO DESIGNATION SOUGHT. Name of School Curriculum or Study Program 11. FAA CERTIFICATES NOW HELD PERTINENT TO DESIGNATION SOUGHT. Type Certificate No* Rating Degrees Received Date Each Rating Issued 12. EMPLOYER S RECOMMENDATION I recommend the person identified above be appointed as Primary Business Signature 13. LOCATION WHERE DESIGNEE FUNCTIONS WILL BE PERFORMED IF DIFFERENT THAN BLOCK 2. Address Telephone Number EMAIL Address Optional 14. CERTIFICATION I certify that the above statements are true to the best of my knowledge and that I am familiar with the Federal Aviation Regulations pertinent to the designation sought. Form Approved OMB-2120-0033 Expiration Date 08-31-2013 3. U*S* CITIZEN STATEMENT OF QUALIFICATIONS DAR-DMIR-DER US Department of Transportation Federal Aviation Administration INSTRUCTIONS Print or type all entries except signatures Yes No 1. NAME Last first middle OR ORGANIZATION 4. DATE OF BIRTH 2. BUSINESS OR COMPANY ADDRESS Number street city state and ZIP code 5. NAME Last first middle OR ORGANIZATION 4. DATE OF BIRTH 2. BUSINESS OR COMPANY ADDRESS Number street city state and ZIP code 5. BUSINESS PHONE NUMBER 6. BUSINESS FAX NUMBER 7. EMAIL ADDRESS 8. DESIGNATION SOUGHT Designated Engineering Representative DER Structural Engineering Engine Engineering Powerplant Engineering Propeller Engineering Company Systems and Equipment Engineering Flight Analyst Consultant Flight Test Pilot Acoustical Engineering Note Manufacturing Function s Designated Airworthiness Representative DAR A separate application must be submitted for each discipline i*e* Manufacturing or Engineering. .

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