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CERTIFICATE OF AIRCREW QUALIFICATION TYPE OF CHECK | AFM 60-1 [[box with a typed X]] PROFICIENCY ☐ INSTRUMENT | MAJOR COMMAND ☐ TACTICAL MISSION | OTHER (Specify) ^ANNUAL| DATE DUE ^18 Jun 68 | DATE COMPLETED ^13 Jun 68 | I. AIRCREW IDENTIFICATION NAME OF EXAMINEE (Last, First, Middle Initial) ^[[DAVIS, BENJAMIN O.]] | GRADE ^[[LT/GEN]] | AFSN ^[[FR1206]] | DATE OF BIRTH ^[[18 Dec]] ORGANIZATION ^[[Hq 13th AF, PACAF, (636 BDOE)]] | BASE ^[[CLARK AB, APO SF 96274]] TYPE AIRCRAFT (Model/Series) ^[[T-39/A]] | CREW POSITION ^[[PCP]] | CREW NUMBER (If applicable) ^[[N/A]] II. PREREQUISITES AERONAUTICAL RATING ^[[Comd Pilot]] | FLYING STATUS CODE ^[[1 Y]] | ELIGIBLE FOR CHECK □ ^[[X]]YES □ NO | AS OF DATE ^[[3 Jun 68]] | ORGANIZATION ^[[636th CSG (BDOE]] DATE ^[[3 JUN 68]] | TYPED NAME AND GRADE OF CERTIFYING OFFICIAL ^[[WILLIAM S. FULLER, Lt Col, USAF]] | SIGNATURE ^[[William S Fuller]] III. QUALIFICATION GROUND PHASE | FLIGHT PHASE EXAMINATION/CHECK | DATE | GRADE | MISSION/CHECK | DATE | TIME ^[[Written Proficiency | 3 Jun 68 | 100% | Proficiency Eval | 13 Jun 68 | 1+30]] | STATUS/GRADE (IAW Command directives) ^[[(PACAFR 60-10) Qual]] | RESTRICTION (As applicable)^[[None]] | EXPIRATION DATE OF RESTRICTION ^[[N/A]] INSTRUMENT RATING (Pilot only) □ NO.1 □ NO.2 | UPGRADE (Include date) □ No.1 | EXPIRATION DATE OF FLIGHT CHECK ^[[18 Jun 69]] DATE ^[[13 Jun 68]] | NAME AND GRADE OF EXAMINEE (Typed)^[[BENJAMIN O. DAVIS, LT/GEN, USAF]] | SIGNATURE ^[[Benjamin O. Davis, Jr.]] IV. CERTIFICATION The above aircrew member has demonstrated [[box with typed X]] satisfactory [[empty box]] unsatisfactory performance and knowledge of procedures, techniques, equipment, and directives which [[box with typed X]] would [[empty box]] would not assure the safe and successful accomplishment of his assigned flying duties. 1 | CHECK AS APPLICABLE (Use reverse side for remarks) [[empty box]] REMARKS | ORGANIZATION ^[[636th CSG (BDOF)]] | DATE ^[[13 Jun 68]] TYPED NAME AND GRADE OF FLIGHT EXAMINER ^[[GERALD K. TAYLOR, MAJOR, USAF]] | SIGNATURE ^[[Gerald K Taylor]] 2 | CHECK APPLICABLE BOX(S) (Use reverse for remarks) □ REMARKS □ ^[[X]] CONCUR □ DO NOT CONCUR | ORGANIZATION ^[[636 CSG (BDOE)]] | DATE ^[[14 Jun 68]] TYPED NAME AND GRADE OF REVIEWING OFFICER ^[[WILLIAMS. FULLER, Lt Col, USAF]] | SIGNATURE ^[[William S Fuller]] 3 | CHECK APPLICABLE BOX(S) (Use reverse for remarks) □ REMARKS □ ^[[X]] CONCUR □ DO NOT CONCUR | ORGANIZATION ^[[636 CSG (BDO)]] | DATE ^[[15 Jun 68]] TYPED NAME AND GRADE OF FINAL APPROVING OFFICER ^[[CLYDE A. HARTSHORN, Lt Col, USAF]] | SIGNATURE ^[[Clyde A Hartshorn]] AF FORM MAR 65 8 PREVIOUS EDITION WILL BE USED.