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Examiner certificate application form and examiner assessment of
competence report
☐ Initial issue (practical syllabus must be attached)
☐ Revalidation / Renewal
☐ Extension (new type, class or role)
APPLICATION FOR, AND REPORT FORM FROM ASSESSMENT OF COMPETENCE
FOR ISSUING OR REVALIDATION OF EXAMINER CERTIFICATE ACCORDING TO
SUBPART K OF COMMISSION REGULATION (EU) NO 1178/2011 OF 3 NOVEMBER
2011
A. Applicant information Last name Licence no
First and middle name Street or box
Zip code and city Country
Mobile phone E-mail
☐ Applicant verification of compliance according to ARA.GEN.315
and AMC1 ARA.GEN.315 (c)(see instructions, page 6)
B. Application for authorisation as (tick all applicable
boxes)Role of examiner
☐ ST-examiner ☐ PC-examiner ☐ SEN-examiner☐ Flight examiner (FE)
☐ Aeroplane ☐ Helicopter ☐ Sailplane
☐ Instrument rating examiner (IRE) ☐ Aeroplane ☐ Helicopter ☐
Sailplane
☐ Class rating examiner(CRE) ☐ Aeroplane ☐ Helicopter ☐
Sailplane
☐ Type rating examiner (TRE) ☐ Aeroplane ☐ Helicopter ☐
Sailplane
☐ Synthetic flight examiner (SFE) ☐ Aeroplane ☐ Helicopter ☐
Sailplane
☐ Flight instructor examiner (FIE) ☐ Aeroplane ☐ Helicopter ☐
Sailplane
C. On the following types/classes of aircraftType / Class Flight
time total on type/class As instructor on type/class 1. 2. 3. 4. 5.
6. IFR flight time / of which as instructor (Initial IRE only):
/
D. Revalidation and renewalLast examiner standardization meeting
attended, place/date (attach certificate of completion) or planned
attendance date
Tests conducted each year as examiner, last three years, as
examiner (PC, Skill test, Assessment of Competence only)
/ / Send the form as a scanned file in pdf-format to:
[email protected] or as mail to:
Transportstyrelsen, SE-601 73 Norrköping
mailto:[email protected]
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Examiner assessment of competence report form (if
applicable)
E. Before assessment Revalidation Renewal
☐ Valid licence ☐ Valid medical (N/A for SFE) ☐ All relevant
type/class ratings valid (N/A for SFE)
☐ Valid relevant Instructor rating (-s) ☐ Personal
identification card
☐ ≥ 2 test/checks per year during the validity period of the
certificate. ☐ Attended examiner refresher seminar within the last
year of the validity period. (or planned attendance date noted on
page 1)
☐ Consultation with the Swedish Transport Agency confirmed
☐ Attended examiner refresher seminar within the last 12 months
(or planned attendance date noted on page 1)
Initial issue
☐ Examiner standardisation course passed within the last 12
months.
☐ Practical training completed (attach protocols to
application)
☐ All prerequisites checked and confirmed including latest
revision of Examiner differences document, revision no:
______________
Senior examiner
Type of test or check observed Aircraft type and registration
(or simulator Qualification no)
Crew member(s)
Name Licence no
Name Licence no
F. Result of the test
Final result ☐ Pass ☐ Fail
☐ Temporary certificate issued ☐ Temporary certificate not
issued Place and date Stamp or printed name
Senior examiner certificate number
Signature of senior examiner
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1. General 0 2 1 1.1 Establishing a relaxed and friendly
atmosphere ☐ ☐ ☐ 1.2 Attitude towards applicant(s) ☐ ☐ ☐ 1.3
Attitude towards senior examiner / inspector ☐ ☐ ☐
2. Pre-flight 0 2 1 2.1 Stating the objectives of the
flight/test ☐ ☐ ☐ 2.2 Checking applicant(s) licence and
identification ☐ ☐ ☐ 2.3 Checking the applicant’s training records,
logbook and/or course completion certificate (including ATO
recommendation if relevant)
☐ ☐ ☐ 2.4 Verification that the applicant(s) meet all applicable
qualification, experience and training requirements for the
licence, rating or certificate applied for
☐ ☐ ☐
2.5 Inviting and allowing questions during the breifing ☐ ☐ ☐
2.6 Setting a practical scenario and indicating all conditions for
the flight ☐ ☐ ☐ 2.7 Setting a relevant test schedule, allowing all
necessary items to be covered ☐ ☐ ☐ 2.8 Giving due regard to
weather, ATC etc. ☐ ☐ ☐ 2.9 Establishing SOP, checklists, charts
and which manuals to be used for the test ☐ ☐ ☐ 2.10 Requesting a
weather assessment from the applicant(s) ☐ ☐ ☐ 2.11 Establishing
the roles and responsibilities to be assumed during the test
(including different roles during a FSTD session)
☐ ☐ ☐
2.12 Briefing the test content, including the expected sequence
of events ☐ ☐ ☐ 2.13 Conducting the oral exam ☐ ☐ ☐ 2.14
Establishing speeds, power settings, configuration for the required
manoeuvres ☐ ☐ ☐ 2.15 Checking of mass and balance calculations ☐ ☐
☐ 2.16 Establish any operational limitations for the test, e.g.
bank angles, speeds etc. ☐ ☐ ☐
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2.17 Establishing and approving operating minima, minimum
descent height and missed approach point ☐ ☐ ☐ 2.18 Briefing of any
relevant safety considerations for simulated or actual abnormal and
emergency procedures (including emergency egress procedures etc.
for tests in FSTDs)
☐ ☐ ☐
2.19 Ensuring the completion of administrative procedures, e.g.
submission of flight plan, PPR etc. ☐ ☐ ☐ 2.20 Verifying that the
aircraft or simulator is airworthy/qualified and suitable. ☐ ☐ ☐ 3.
Test session 0 2 1 3.1 Avoiding negative remarks and criticism
during the test ☐ ☐ ☐ 3.2 Ensuring that the applicant operated the
aircraft as PIC and carried out the test as if no other crew
members were present (SP tests)
☐ ☐ ☐
3.3 Testing the applicant(s) as both PF and PNF (MP tests) ☐ ☐ ☐
3.4 Avoiding to take any part in the operation of the aircraft
except where intervention was necessary in the interests of
safety
☐ ☐ ☐
3.5 Avoiding the role of an instructor ☐ ☐ ☐ 3.6 Ensuring that
the applicant(s) could perform the test to the best of their
ability ☐ ☐ ☐ 3.7 Maintaining a flight and assessment log ☐ ☐ ☐ 3.8
Conducting the test as briefed ☐ ☐ ☐ 3.9 Ensuring that the
applicant(s) understand and accept any changes to the test schedule
☐ ☐ ☐ 3.10 Assessing all items separately ☐ ☐ ☐ 3.11 Not allowing
marginal or questionable performance of one test item to influence
the assessment of a subsequent item
☐ ☐ ☐
3.12 Allowing sufficient time for each manoeuvre ☐ ☐ ☐ 3.13
Handling of repeated items (if applicable) ☐ ☐ ☐ 3.14 Using a
suitable means of screening to simulate IMC for any manoeuvres
required to be flown by sole reference to instruments
☐ ☐ ☐
3.15 Handling the aircraft or simulator when necessary ☐ ☐ ☐
3.16 Displaying good airmanship and flight discipline during the
test ☐ ☐ ☐
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4. Assessment 0 2 1 4.1 Assessing the candidate(s) against the
required test standards ☐ ☐ ☐ 4.2 Correctly applying the
Pass/Partial Pass/Fail criteria ☐ ☐ ☐ 4.3 Giving due regard to test
conditions ☐ ☐ ☐
5. Post-flight 0 2 1 5.1 Delivering a clear result of the test ☐
☐ ☐ 5.2 Stating any reasons for a failed or partially passed test ☐
☐ ☐ 5.3 Stating re-training requirements (if applicable) ☐ ☐ ☐ 5.4
Stating re-test requirements (if applicable) ☐ ☐ ☐ 5.5 Giving
constructive criticism and offering advise on how to correct any
errors ☐ ☐ ☐ 5.6 Providing the applicant(s) the signed test report
☐ ☐ ☐ 5.7 Completing the necessary test report and application
forms ☐ ☐ ☐ 5.8 Completing the necessary license administration ☐ ☐
☐
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G. Remarks
Item no Comment
Disagreement with or comment on senior examiner´s report
Signature of applicant
H. Additional information
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BSL 14368 - INSTRUCTIONS FOR COMPLETING FORM
This form must be used for when applying for the issue,
revalidation, renewal or extension of examiner certificates. A copy
of the form shall be submitted by the senior examiner to the
address indicated on the bottom of page one.
A. The applicant shall enter all the information required
AMC1 ARA.GEN.315 Applicant VERIFICATION OF COMPLIANCEBy ticking
this box you certify that you:(1) do not hold any personnel
licence, certificate, rating, authorisation or attestation with
thesame scope and in the same category issued in another Member
State;(2) has not applied for any personnel licence, certificate,
rating, authorisation or attestationwith the same scope and in the
same category in another Member State; and(3) has never held any
personnel licence, certificate, rating, authorisation or
attestation with thesame scope and in the same category issued in
another Member State which was revoked orsuspended in any other
Member State.Incorrect information could disqualify you from being
granted a personnel licence, certificate,rating, authorization or
attestation.
B. The applicant shall tick all applicable examiner roles for
which examiner privileges are sought,according to his/her
instructor ratings.
C. The types and classes on which tests/checks are to be
conducted on and the flight time ontypes/classes respectively.
Please note that the instrument flight time and instrument
instructing timeis only relevant for the first issue of IRE
authorisation.
D. For revalidation or renewal the certificate of completion
from the last attended examinersstandardization meeting must be
attached or planned attendance date noted.
E. The senior examiner shall tick all applicable boxes and enter
the relevant information.
F. The senior examiner shall enter the result of the test and
sign the form. If the examiner does not havea stamp he/she must
type out the examiner certificate number. The grading of the test
items is to bedone as follows:
0. Pass - Completed without any errors or mistakes2. Pass -
Completed with minor errors or mistakes
i. Indicates room for improvement, but an acceptable level.ii.
Examples of minor errors and mistakes could be
1. Errors in administration forms2. Assuming an instructor role,
without affecting the outcome of the test3. Incorrect setting of
simulator, which is corrected4. Having to extend the time frame of
the test due to poor planning
1. Fail - Completed with major errors or mistakesiii. Indicates
an unacceptable leveliv. Examples of major errors or mistakes could
be
1. Awarding the wrong result2. Not including all mandatory
items3. Assuming an instructor role, and affecting the outcome of
the test4. Creating a hostile environment
G. The senior examiner shall note all errors and mistakes under
remarks, with a reference to the relevantitem. Please bear in mind
that this information will also be used for examiner
standardizationpurposes so a clear description of the events is
required.
H. The senior examiner shall enter any other relevant
information regarding the test, e.g. test completedon two separate
occasions due to weather etc.
Initial issue practical syllabus must be attached:
OffRevalidation Renewal: OffExtension new type class or role:
OffLast name: Licence no: First and middle name: Street or box: Zip
code and city: Country: Mobile phone: Email: undefined:
Offundefined_2: Offundefined_3: Offundefined_4: OffAeroplane:
OffHelicopter: OffSailplane: OffInstrument rating examiner IRE:
OffAeroplane_2: OffHelicopter_2: OffSailplane_2: OffClass rating
examinerCRE: OffAeroplane_3: OffHelicopter_3: OffSailplane_3:
OffType rating examiner TRE: OffAeroplane_4: OffHelicopter_4:
OffSailplane_4: OffSynthetic flight examiner SFE: OffAeroplane_5:
OffHelicopter_5: OffSailplane_5: OffFlight instructor examiner FIE:
OffAeroplane_6: OffHelicopter_6: OffSailplane_6: OffFlight time
total on typeclass1: As instructor on typeclass1: Flight time total
on typeclass2: As instructor on typeclass2: Flight time total on
typeclass3: As instructor on typeclass3: Flight time total on
typeclass4: As instructor on typeclass4: Flight time total on
typeclass5: As instructor on typeclass5: Flight time total on
typeclass6: As instructor on typeclass6: IFR flight time of which
as instructor Initial IRE only: Last examiner standardization
meeting attended placedate attach certificate of completion or
planned attendance date: Valid licence: OffValid medical NA for
SFE: OffAll relevant typeclass ratings: Offtoggle_6:
OffConsultation with the: OffAttended examiner refresher:
OffAttended examiner refresher_2: OffValid relevant Instructor:
OffPersonal identification card: OffExaminer standardisation course
passed within the: OffAll prerequisites checked and confirmed:
Offdocument revision no: Practical training completed attach
protocols to: OffType of test or check observed: Aircraft type and
registration or simulator Qualification no: Name: Licence no_2:
Name_2: Licence no_3: Pass: OffFail: OffTemporary certificate
issued: OffTemporary certificate not issued: OffPlace and date:
Senior examiner certificate number: Signature of senior examiner:
Item noRow1: CommentRow1: H Additional informationRow1: Text1:
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