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[[preprinted form]] CERTIFICATE OF AIRCREW QUALIFICATION TYPE OF CHECK AFM 60-1 □ ^[[X]] PROFICIENCY □ ^[[X]] INSTRUMENT MAJOR COMMAND □ TACTICAL MISSION OTHER (Specify) ^[[PCP UPGRADE]] DATE DUE ^[[18 Dec 67]] DATE COMPLETED ^[[Feb 68]] I. AIRCREW IDENTIFICATION NAME OF EXAMINEE (Last, First, Middle Initial) ^[[DAVIS, BENJAMIN O.]] GRADE ^[[LT/GEN]] AF SN ^[[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) ^[[N/A]] II PREREQUISITES AERONAUTICAL RATING ^[[Comd Pilot]] FLYING STATUS CODE ^[[1Y]] ELIGIBLE FOR CHECK □ ^[[X]] YES □ NO AS OF DATE ^[[7 Feb 68]] ORGANIZATION ^[[636 CSG (BDOE)]] DATE ^[[7 Feb 68]] TYPED NAME AND GRADE OF CERTIFYING OFFICIAL ^[[WILLIAM S. FULLER, LT COL, USAF]] SIGNATURE ^[[William S Fuller]] III. QUALIFICATION [[6 column table]] GROUND PHASE EXAMINATION/CHECK | GROUND PHASE DATE | GROUND PHASE GRADE | FLIGHT PHASE MISSION/CHECK | FLIGHT PHASE DATE | TIME | ^[[Written Proficiency | 8 Jan 68 | 100 | Proficiency Eval | 5 Feb 68 | 2:00 |]] ^[[ACAD INST REF CRSE | 4 Feb 68 | 100 | Instrument Eval | 5 Feb 68 | 2:50 |]] | | | AND | | | | | | PCP Upgrade | | | STATYS/GRADE (I AW Command directives) ^[[(PACAFM 60-39) 71.7]] 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 ^[[Instr. 18 Dec 68 Prof. 18 Jun 68]] DATE ^[[5 Feb 68]] NAME AND GRADE OF EXAMINEE (Typed) ^[[BENJAMIN O. DAVIS, LT/GEN, USAF]] SIGNATURE ^[[B.O. DAVIS Jr.]] IV. CERTIFICATION The above aircrew member has demonstrated □ ^[[x]] satisfactory □ unsatisfactory 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 ^[[6 Feb 68]] TYPE NAME AND GRADE OF FLIGHT EXAMINER ^[[WILLIAM E POWERS, MAJOR, USAF]] SIGNATURE ^[[William E Powers]] 2 CHECK APPLICABLE BOS(S) (Use reverse for remarks) □ REMARKS □ ^[[x]] CONCUR □ DO NOT CONCUR ORGANIZATION ^[[636 CSG (BDOF)]] DATE ^[[6 Feb 68]] TYPE NAME AND GRADE OF REVIEWING OFFICER ^[[DARRELL G. FAULKNER, LT COL, USAF]] SIGNATURE ^[[Darrell G. Faulkner]] 3 CHECK APPLICABLE BOX(S) (Use reverse for remarks)]] □ REMARKS □ ^[[X]] CONCUR □ DO NOT CONCUR ORGANIZATION ^[[636 CSG (BDOE)]] DATE ^[[7 Feb 68]] TYPE NAME AND GRADE OF FINAL APPROVING OFFICER ^[[WILLIAM S. FULLER, LT COL, USAF]] SIGNATURE ^[[William S Fuller]] AF Form 8 Mar 65 PREVIOUS EDITION WILL BE USED