Appendix 1 APPENDIX 1. REQUIRED 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 Airworthiness Program Manager)
AIRCRAFT MAINTENANCE TECHNICIAN AWARDS PROGRAM
TECHNICIAN AWARD APPLICATION (This form may be duplicated as long as the submitted document is 8 ½” by 3 ¾”)
(Applicant must contact the local FSDO, CMO, or IFO, for the name and phone number of the FAASTeam Program Manager Airworthiness responsible for the area and make an appointment to have his/her application and training records reviewed)
Check the Phase for which you are applying:
□ Phase I □ Phase II □ Phase III □ Phase IV □ Phase V Today’s Date: _________________________
Applicant’s Name: _______________________________________________ Address: ________________________________________________________ City: _______________________________________________ State: ________________________________________________ Zip: _________________________________________________ FAA Certificate # _________________________________________ Home Phone # (Optional): ___________________________________ Work Phone #: _______________________________
AMT APPLICATION FORM Applicant’s Name: ___________________________________ Award Applied For: ______________________ Applicant’s Home Address : ______________________________________________________________________ _____________________________________________________________________________________________ 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.)
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AMT APPLICATION FORM Applicant’s Name: __________________________________ Award Applied For: ______________________ Applicant’s Home Address: ______________________________________________________________________ _____________________________________________________________________________________________ Home Phone # (Optional): ___________________________ Work Phone #: _______________________________ Employer/School:
______________________________________________________________________________________ Employer’s/School’s Address:
____________________________________________________________________________ ______________________________________________________________________________________________ FSDO: ____________________________________________________ (Please submit evidence of training with this application.)
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Appendix 2 APPENDIX 2. AIRCRAFT MAINTENANCE TECHNICIAN AWARDS PROGRAM
EMPLOYER AWARD APPLICATION (This form may be duplicated.)
(To be sent to the local FSDO, CMO, or IFO, which will forward to the FAASTeam Airworthiness Program Manager responsible for the area)
Company Name:________________________________________________________________ Address:______________________________________________________________________ Telephone Number:____________________________________ Date:_____________________ □ Gold Certificate of Excellence □ Diamond Certificate of Excellence □ Five-year Special Recognition Plaque
_______________________________________________________ I certify that the information contained in this application is true.
_______________________________________________________ Authorized company official submitting this application.
______________________________________________________________________________
NAME TITLE SIGNATURE DATE
NOTE: Upon determining that the employer is eligible, the local FSDO, CMO, IFO, or FAASTeam Airworthiness Program Manager will process the application and issue the Gold or Diamond Certificate of Excellence and/or forward the Employer Application for the Five Year Recognition to the Deputy National FAASTeam Manager, ATTN: AFS-8A, 800 Independence Ave., SW, Washington, DC 20591, who will issue the Five Year Special Recognition award.
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