Appendix 1 APPENDIX 1. SUGGESTED FORMAT
AIRCRAFT MAINTENANCE TECHNICIAN AWARDS PROGRAM
TECHNICIAN AWARD APPLICATION (This form may be duplicated) (To be sent to the local FSDO, CMO, IFO, or FAASTeam representative)
AMT APPLICATION FORM Applicant’s Name: _______________________________________________ Award Applied For:
______________________ Applicant’s Home Address (Optional): ______________________________________________________________________
_____________________________________________________________________________________________________ Home Phone # (Optional): ___________________________________ Work Phone #:
_______________________________ Employer/School: ______________________________________________________________________________________
Employer’s/School’s Address: ____________________________________________________________________________ _____________________________________________________________________________________________________ FSDO: _________________________________________________________________ Tie tack/pin: Yes______ No______ (Please submit evidence of training with this application.)
AMT APPLICATION FORM Applicant’s Name: _______________________________________________ Award Applied For:
______________________ Applicant’s Home Address (Optional): ______________________________________________________________________
_____________________________________________________________________________________________________ Home Phone # (Optional): ___________________________________ Work Phone #:
_______________________________ Employer/School: ______________________________________________________________________________________ Page 1
Appendix 1 APPENDIX 1. SUGGESTED FORMAT (Continued)
AIRCRAFT MAINTENANCE TECHNICIAN AWARDS PROGRAM
EMPLOYER AWARD APPLICATION (This form may be duplicated.)
(To be sent to the local FSDO, CMO, IFO, or FAASTeam representative)
Company Name_______________________________________________________________
Address_____________________________________________________________________
Telephone Number____________________________________Date____________________
( ) PHASE I — Bronze Award ( ) PHASE II — Silver Award ( ) PHASE III — Gold Award ( ) PHASE IV — Ruby Award ( ) PHASE V — Diamond Award
Number of mechanics or technicians employed_______________________________________
Number of Certificates of Training received by employees______________________________
LIST THE NAMES OF EMPLOYEES RECEIVING AWARDS AND AWARD TYPE.
(Use additional sheets, if necessary.)
NAME AWARD DATE ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
I certify that the information contained in this application is true.
Authorized company official submitting this application.
NAME TITLE SIGNATURE DATE Page 2