William "Rick" Rundell

Designated Pilot Examiner (DPE)

Call or Text:

(954)-663-9951

Email: DPE@JetMailbox.com

Applicant Information Request Document

Full Name on Pilot License *

Phone *

Email *

Test Type *

Rating Type *

FAR Training *

School Name and FAA Designation *

Age - Date of Birth (Example: 34 - 08/16/1989) *

Is your permanent address the same as your mailing address? *

Permanent Address *

Mailing Address *

FTN (FAA Tracking #) *

FAA Application # *

Grade of Existing Pilot Certificate *

Pilot Certificate Number *

Is this a Foreign Based License? *

Medical Class *

Last Medical Date *

History of Drug Convictions/Vehicle Actions? *

If Yes, Date of Last Conviction *

Previous Disapproval or Denial for Requested Certificate? *

Requested Date for Examination *

Check-Ride Location: Airport Code and FBO - Location Name *

Check Ride Location Address *

Aircraft Make/Model/Tail *

Recommending CFI Name (First, Middle, Last) *

Recommending CFI Certificate # *

Recommending CFI Certificate Expiration Date *

Recommending CFI Phone *

Recommending CFI Email *

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Disclaimer:

14.CFR Part 183 allows the FAA to designate a private individual to conduct practical tests, issue certificates and conduct other administrative functions on behalf of the FAA.

An FAA Designated Pilot Examiner is not an employee of the FAA. DPE's are governed by 14.CFR.Part 183, Parts 61, 91, FAA

Technical order 8900.2C., 8000.95b., and the respective ACS / PTS documents and other local FSDO norms.