DD Form 1821 Contractor Crewmember Record

DD Form 1821 or the "Contractor Crewmember Record" is a Department of Defense-issued form used by and within the United States Army.

The form - often mistakenly referred to as the DA form 1821 - was last revised on August 1, 1996. Download an up-to-date fillable PDF version of the DD 1821 down below or find it on the Department of Defense documentation website.

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Form Approved
CONTRACTOR CREWMEMBER RECORD
OMB No. 0704-0188
The public reporting burden for this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding
any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION.
PRIVACY ACT STATEMENT
AUTHORITY: 10 USC 8012, 44 USC 3101, and EO 9397, November 1943 (SSN).
PURPOSE AND USE: To record individual contractor flight crew personnel records and approval to operate Government aircraft. Serves as a
record of approval of private contractor personnel who will operate Government aircraft.
DISCLOSURE: Voluntary; however, failure to complete form will prevent approval of contractor flight crew members from operating
Government aircraft.
NAME OF CREWMEMBER (First, last, middle initial)
CONTRACTOR REPRESENTED (Name and address)
IDENTIFY CREW POSITION
TEST
SUPPORT
FUNCTIONAL
OTHER (Specify)
MISSION, DESIGN AND SERIES AIRCRAFT OR OTHER REQUIREMENT
BASE OR LOCATION WHERE QUALIFICATION ACCOMPLISHED
FOR THIS QUALIFICATION
INITIAL QUALIFICATION
REQUALIFICATION
SECTION I - FLIGHT EXPERIENCE (Time to nearest hour)
TOTAL FLYING TIME
FLYING TIME ABOVE TYPE
0
JET
HRS
TURBO PROP
HRS
RECIPROCATING
HRS ROTARY
HRS
OTHER
MISSION
PERIOD
1ST PILOT
AIRCRAFT
CREW
DESIGN AND
OF
IP
COPILOT
COMMANDER
MEMBERS
SERIES AIRCRAFT
TIME
TOTAL
WX
HOOD
NIGHT
(Specify)
LAST 12 MOS
LAST 4 YRS
0
0
0
0
0
0
0
0
TOTAL
LAST 12 MOS
LAST 4 YRS
0
0
0
0
0
0
0
0
TOTAL
LAST 12 MOS
LAST 4 YRS
0
0
0
0
0
0
0
0
TOTAL
LAST 12 MOS
LAST 4 YRS
0
0
0
0
0
0
0
0
TOTAL
LAST 12 MOS
LAST 4 YRS
0
0
0
0
0
0
0
0
TOTAL
LAST 12 MOS
LAST 4 YRS
0
0
0
0
0
0
0
0
TOTAL
LAST 12 MOS
LAST 4 YRS
0
0
0
0
0
0
0
0
TOTAL
Page 1 of 3 Pages
DD FORM 1821, AUG 96
PREVIOUS EDITION MAY BE USED
Reset
Adobe Professional 7.0
Form Approved
CONTRACTOR CREWMEMBER RECORD
OMB No. 0704-0188
The public reporting burden for this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding
any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION.
PRIVACY ACT STATEMENT
AUTHORITY: 10 USC 8012, 44 USC 3101, and EO 9397, November 1943 (SSN).
PURPOSE AND USE: To record individual contractor flight crew personnel records and approval to operate Government aircraft. Serves as a
record of approval of private contractor personnel who will operate Government aircraft.
DISCLOSURE: Voluntary; however, failure to complete form will prevent approval of contractor flight crew members from operating
Government aircraft.
NAME OF CREWMEMBER (First, last, middle initial)
CONTRACTOR REPRESENTED (Name and address)
IDENTIFY CREW POSITION
TEST
SUPPORT
FUNCTIONAL
OTHER (Specify)
MISSION, DESIGN AND SERIES AIRCRAFT OR OTHER REQUIREMENT
BASE OR LOCATION WHERE QUALIFICATION ACCOMPLISHED
FOR THIS QUALIFICATION
INITIAL QUALIFICATION
REQUALIFICATION
SECTION I - FLIGHT EXPERIENCE (Time to nearest hour)
TOTAL FLYING TIME
FLYING TIME ABOVE TYPE
0
JET
HRS
TURBO PROP
HRS
RECIPROCATING
HRS ROTARY
HRS
OTHER
MISSION
PERIOD
1ST PILOT
AIRCRAFT
CREW
DESIGN AND
OF
IP
COPILOT
COMMANDER
MEMBERS
SERIES AIRCRAFT
TIME
TOTAL
WX
HOOD
NIGHT
(Specify)
LAST 12 MOS
LAST 4 YRS
0
0
0
0
0
0
0
0
TOTAL
LAST 12 MOS
LAST 4 YRS
0
0
0
0
0
0
0
0
TOTAL
LAST 12 MOS
LAST 4 YRS
0
0
0
0
0
0
0
0
TOTAL
LAST 12 MOS
LAST 4 YRS
0
0
0
0
0
0
0
0
TOTAL
LAST 12 MOS
LAST 4 YRS
0
0
0
0
0
0
0
0
TOTAL
LAST 12 MOS
LAST 4 YRS
0
0
0
0
0
0
0
0
TOTAL
LAST 12 MOS
LAST 4 YRS
0
0
0
0
0
0
0
0
TOTAL
Page 1 of 3 Pages
DD FORM 1821, AUG 96
PREVIOUS EDITION MAY BE USED
Reset
Adobe Professional 7.0
SECTION II - FLIGHT CHECK (Instructor fill in remarks where applicable)
1. PREFLIGHT INSPECTION
7. IN-FLIGHT EMERGENCY
AND FORMS
PROCEDURES
2. EMERGENCY ESCAPE
8. PRELANDING CHECK, TRAFFIC
PROCEDURES
PATTERN AND LANDINGS
3. PRESTART COCKPIT PRO-
9. POSTFLIGHT INSPECTION
CEDURE AND ENGINE START
4. COMMUNICATIONS AND
10. ACCOMPLISHMENT OF FORMS
TAXI PROCEDURES
AND AIRCRAFT SECURITY
5. PRETAKEOFF COCKPIT CHECK
11. INSTRUMENT PROFICIENCY
AND ENGINE RUNUP
CHECK
6. TAKEOFF AND FLIGHT
12. OTHER (Specify)
PROCEDURES
SECTION III - ADDITIONAL REQUIREMENTS (Fill in where applicable)
REQUIREMENT
CHECKED BY
GRADE
DATE AND PLACE
HOURS
13. PHYSICAL EXAMINATION
14. PHYSIOLOGICAL/ATTITUDE
INDOCTRINATION
15. PRESSURE SUIT TRAINING
16. GROUND SCHOOL (By Subject)
AIRCRAFT GENERAL
AIRCRAFT PREFLIGHT
AIRCRAFT EMERGENCY PROCEDURE
ENGINE SYSTEM
OXYGEN SYSTEM
AIR CONDITIONING
PRESSURIZATION
FUEL SYSTEM
INSTRUMENT SYSTEM
ELECTRICAL SYSTEM
HYDRAULIC POWER SYSTEM
UTILITY SYSTEM
FLIGHT CONTROL SYSTEM
AUTO PILOT SYSTEM
ENGINE
COMMUNICATIONS & NAVIGATION
ROTARY SYSTEM
OTHER REQUIREMENTS AS STATED
IN APPROVED CONTR OPR PROCD
17. QUESTIONNAIRE ON AIRCRAFT
18. FLIGHT SIMULATOR
19. SURVIVAL SCHOOL
20. OTHER (Specify)
21. HAVE YOU EVER HAD AN AIRCRAFT ACCIDENT (as defined by FAR or military procedures) OR PHYSIOLOGICAL REACTION (e.g.,
hypoxia, decompression sickness, hyperventilation, spatial disorientation) AS A PILOT, OR OTHER CREW MEMBER? (If yes, explain.)
22. HAVE YOU EVER BEEN CHARGED WITH A FLYING VIOLATION? (If so, state the violation and circumstances.)
23. REMARKS (For additional space use blank sheet.)
DD FORM 1821, AUG 96
Page 2 of 3 Pages
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CERTIFICATION OF QUALIFICATION
This is to certify that
(Name and Crew Position)
has satisfactorily completed the training or special qualification indicated hereon:
DATE
CERTIFYING
YEAR
TRAINING OR SPECIAL QUALIFICATIONS
COMPLETED
OFFICIAL
GROUND PHASE
WRITTEN EXAMINATION
EMERGENCY PROCEDURES
CONTRACTOR FLIGHT OPERATIONS PROCEDURES
EGRESS TRAINING
PHYSIOLOGICAL TRAINING
OTHER (Specify)1
FLIGHT PHASE
PROFICIENCY
INSTRUMENT
OTHER (Specify)1
GROUND PHASE
WRITTEN EXAMINATION
EMERGENCY PROCEDURES
CONTRACTOR FLIGHT OPERATIONS PROCEDURES
EGRESS TRAINING
PHYSIOLOGICAL TRAINING
OTHER (Specify)1
FLIGHT PHASE
PROFICIENCY
INSTRUMENT
OTHER (Specify)1
1 Formation, Refueling, Night or other special maneuver requirements.
SECTION IV - CERTIFICATIONS
I certify that I have read and understand all pertinent technical orders, handbooks, contractor's operating procedures, and pilot's operating
instructions pertaining to the above aircraft.
DATE
SIGNATURE OF CREWMEMBER
The above named crewmember has/has not demonstrated proficiency in, and has/has not a satisfactory knowledge of
MDS aircraft and has/has not satisfactorily completed the flight requirements for the type of
flight check indicated above, and is/is not fully qualified in this type aircraft.
hours dual,
hours solo,
landings from right (or rear) seat,
The checkout consisted of
landings from left (or front) seat.
and
DATE
BASE OR HOME STATION OF INSTRUCTOR
TYPED OR PRINTED NAME OF INSTRUCTOR
SIGNATURE OF INSTRUCTOR
DD FORM 1821, AUG 96
Page 3 of 3 Pages
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