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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