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FORMS    95

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CANADA

AIR REGULATIONS

APPLICATION FOR AIR ENGINEER'S CERTIFICATE

(TO BE SUBMITTED IN DUPLICATE)

Name of applicant in full (In Block Capitals, Surname Preceding ______________________________
Permanent address _______________________________________
Nationality ___________________
Place of birth _________________________
Date of birth ___________________________

CONTROLLER OF CIVIL AVIATION,
DEPARTMENT OF TRANSPORT,
OTTAWA, ONT.

Application is hereby made for an Air Engineer's Certificate for the purposes and types of aircraft, aero engines and instruments specified:-

(a) Inspection of aircraft before flight ___________________________________________
(b) Inspection of aircraft after overhaul __________________________________________
(c) Inspection of aero engines before flight _______________________________________
(d) Inspection of aero engines after overhaul ______________________________________

I have had the following aviation experience:-
[[4 columned table]]
| Employer | Date From | Date To | Nature of duties |
|---|---|---|---|
|   |   |   |   |
|   |   |   |   | 
|   |   |   |   |
|   |   |   |   |
|   |   |   |   |
|   |   |   |   |
|   |   |   |   |

I attach at least three certificates of competency containing proof of experience as required in Condition 4 overleaf, from:-
[[2 columned table]]
| Name | Office or function |
|---|---| 
|   |   |
|   |   |
|   |   |
|   |   |
             
I hereby declare that the above particulars are true in every respect.
I am prepared upon notice to attend at the aerodrome at ___________________ and submit to such examinations and tests as may be set by the examining officer.

I enclose two unmounted photographs of myself (not larger than 2" x 3", the head to be at least 1/2").

Signature of Applicant _______________________
Date of application __________________________

Form 2400