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[[preprinted]]
CERTIFICATE OF AIRCREW QUALIFICATION
TYPE OF CHECK
AFM 60-1 □ ^[[X]] PROFICIENCY
□ INSTRUMENT
MAJOR COMMAND    □ TACTICAL MISSION
OTHER (Specify) ^[[ANNUAL]]
DATE DUE ^[[18 Jun 68]]
DATE COMPLETED ^[[13 Jun 68]]
AIRCREW IDENTIFICATION
NAME OF EXAMINEE (Last, First, Middle Initial)
^[[DAVIS, BENJAMIN O.]]
GRADE ^[[LT/GEN]]   AFST ^[[FR1206]]
DATE OF BIRTH ^[[18 Dec]]
ORGANIZATION ^[[Hq 13th AF, PACAF, (636 BDOE)
BASE ^[[CLARK AB, APO SF 96274]]
TYPE OF AIRCRAFT (Model/Series) ^[[T-39/A]]
CREW POSITION ^[[PCP]]
CREW NUMBER (If applicable)
II. PREREQUISITES
AERONOUTICAL RATING ^[[Comd Pilot]]
FLYING STATUS CODE ^[[1Y]]
ELIGIBLE FOR CHECK  □ ^[[X]] YES  □ NO
AS OF DATE ^[[3 Jun 68]]
ORGANIZATION ^[[636 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     PILOT PHASE
EXAMINATION/CHECK ^[[Written Proficiency]]
DATE ^[[3 Jun 68]]   GRADE ^[[100%]]
MISSION/CHECK ^[[Proficiency Eval]]
DATE ^[[13 Jun 68]]   TIME ^[[1430]]
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 □ ^[[x]] satisfactorily □ unsatisfactorily performance and knowledge of procedures, techniques, equipment, and directives which   □ [[x]] would  □ would not assure the safe and successful accomplishment of his assigned flying duties.
1  CHECK AS APPLICABLE (Use reverse side for remarks)  □ REMARKS
ORGANIZATION ^[[636 CSG (BDOF)]] 
DATE ^[[13 Jun 68]]
TYPED NAME AND GRADE OF FLIGHT EXAMINER ^[[GERALD K. TAYLOR, LT COL, USAF]]
SIGNATURE ^[[Gerald K Taylor]]
2 CHECK THE 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
^[[WILLIAM S. 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 69]]
TYPED NAME AND GRADE OF FINAL APPROVING OFFICER ^[[CLYDE A HARTSHORN, LT COL, USAF]]
SIGNATURE ^[[Clyde A Hartshorn]]
AF Form 8 Mar 65  PREVIOUS EDITION WILL BE USED.