DME Supplemental Information Sheet

DME SUPPLEMENTAL INFORMATION

This sample document, or a similar format may be used to provide supplemental information to support eligibility, and qualifications for appointment as a FAA Designated Mechanic Examiner (DME).

Describe your experience that pertains to qualifications for a Designated Mechanic Examiner (DME). Please be detailed in your responses in order to support your experience. Refer to FAA Order 8000.95 Designee Management System, Volume 5 for minimum experience requirements for a DME. You may attach additional experience pages as necessary.

Name of Employer/Organization:	Telephone Number:
Street Address:	City:
State (Country if other than USA):	Zip/Postal Code:
Job/Position Title:	Dates Employed: From: ________________ To:___________________
Supervisor’s Name:	FAA Air Agency or Air Operator Certificate Number (If applicable):
Experience (add additional pages if needed):

Name of Employer/Organization:	Telephone Number:
Street Address:	City:
State (Country if other than USA):	Zip/Postal Code:
Job/Position Title:	Dates Employed: From: ________________ To:___________________
Supervisor’s Name:	FAA Air Agency or Air Operator Certificate Number (If applicable):
Experience (add additional pages if needed):

Name of Employer/Organization:	Telephone Number:
Street Address:	City:
State (Country if other than USA):	Zip/Postal Code:
Job/Position Title:	Dates Employed: From: ________________ To:___________________
Supervisor’s Name:	FAA Air Agency or Air Operator Certificate Number (If applicable):
Experience (add additional pages if needed):

Name of Employer/Organization:	Telephone Number:
Street Address:	City:
State (Country if other than USA):	Zip/Postal Code:
Job/Position Title:	Dates Employed: From: ________________ To:___________________
Supervisor’s Name:	FAA Air Agency or Air Operator Certificate Number (If applicable):
Experience (add additional pages if needed):

Name of Employer/Organization:	Telephone Number:
Street Address:	City:
State (Country if other than USA):	Zip/Postal Code:
Job/Position Title:	Dates Employed: From: ________________ To:___________________
Supervisor’s Name:	FAA Air Agency or Air Operator Certificate Number (If applicable):
Experience (add additional pages if needed):

FAA Certificates Held

Provide the details of any FAA certificates held. For repairman certificates, also include the limitations stated on the certificate in the “RATINGS” column.

CERTIFICATE TYPE	CERTIFICATE NUMBER	RATINGS	DATE OF ISSUANCE

Fixed Base of Operation

Address of applicant’s fixed base of operation equipped to support testing in both reciprocating and turbine engine aircraft: