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CERTIFICATE OF AIRCREW QUALIFICATION TYPE OF CHECK | AFM 60-1 [[box with a typed X]] PROFICIENCY [[box with a typed X]] INSTRUMENT | MAJOR COMMAND [[box with no X]] TACTICAL MISSION | OTHER (Specify) | DATE DUE 18 Jun 68 | DATE COMPLETED 9 Aug 68 | I. AIRCREW IDENTIFICATION NAME OF EXAMINEE (Last, First, Middle Initial) ^[[DAVIS, BENJAMAN O.]] GRADE ^[[LT/GEN]] AFSN ^[[FR1206]] DATE OF BIRTH ^[[18 Dec]] ORGANIZATION ^[[836th Combat Support Group]] BASE ^[[MacDill Air Force Base, Florida]] TYPE AIRCRAFT (Model/Series) ^[[T-39/A]] CREW POSITION ^[[Pilot]] CREW NUMBER (If applicable) ^[[N/A]] II. PREREQUISITES AERONAUTICAL RATING ^[[Command Pilot]] FLYING TIME CODE ^[[1 Y]] ELIGIBLE FOR CHECK □ ^[[X]]YES □ NO AS OF DATE ^[[17 Jun 68]] ORGANIZATION ^[[836th Cmbt Spt Gp]] DATE ^[[12 Aug 68]] TYPED NAME AND GRADE OF CERTIFYING OFFICIAL ^[[CAROL L. HOLLEY, MAJOR]] SIGNATURE ^[[Carol L Holley]] III. QUALIFICATION GROUND PHASE | FLIGHT PHASE EXAMINATION/CHECK | DATE | GRADE | MISSION/CHECK | DATE | TIME ^[[PROF. WRITTEN | 17 Aug 68 | Sat. | ANNUAL PROF. | 9 Aug 68 | 1+25]] | STATUS/GRADE (IAW Command directives) ^[[Q/TAC REG 60-2]] RESTRICTION (As applicable)^[[None]] EXPIRATION DATE OF RESTRICTION ^[[N/A]] INSTRUMENT RATING (Pilot only) □ ^[[x]] No.1 □ No.2 UPGRADE (Include date) □ No.1 EXPIRATION DATE OF FLIGHT CHECK ^[[18 Jun 68]] DATE ^[[9 Aug 68]] NAME AND GRADE OF EXAMINEE (Typed) ^[[BENJAMIN O. DAVIS, LT/GEN]] SIGNATURE ^[[B.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 ^[[836th CSGp]] DATE ^[[9 Aug 68]] TYPED NAME AND GRADE OF FLIGHT EXAMINER ^[[NELSON J. SPRAGUE, CAPT]] SIGNATURE ^[[Nelson J. Sprague]] 2 CHECK APPLICABLE BOX(S) (Use reverse for remarks) □ REMARKS □ CONCUR □ DO NOT CONCUR ORGANIZATION ^[[836th CSGp]] DATE ^[[12 Aug 68]] TYPED NAME AND GRADE OF REVIEWING OFFICER ^[[RONALD L. EDWARDS, MAJOR]] SIGNATURE ^[[Carol L. Holley for]] 3 CHECK APPLICABLE BOX(S) (Use reverse for remarks) □ REMARKS □ CONCUR □ DO NOT CONCUR ORGANIZATION ^[[836th CSGp]] DATE ^[[13 Aug 68]] TYPED NAME AND GRADE OF FINAL APPROVING OFFICER ^[[CHARLES A. RILEY, LT COL]] SIGNATURE ^[[Carol L. Holley for]] AF FORM 8 MAR 65 PREVIOUS EDITION WILL BE USED.