afety authority dasr form 19 application for issue ... · pdf fileexisting dasr 66 maml or...

DEFENCE AVIATION SAFETY AUTHORITY
Application for issue/Amendment of DASR 66 Military Aircraft Maintenance Licence
DASR Form 19
Guidance These guidelines are designed to assist you to complete the DASR Form 19 under Defence Aviation Safety Regulation (DASR) 66.
Please carefully read this document and any relevant Acceptable Means of Compliance and Guidance Material issued by DASA. This information is available on the DASA website and will assist with the application process.
About this form and application process
Application Process Completing this application form is the first step in the application process. Once received, DASA will review your application including all supporting documentation provided.
Where an applicant is employed by an organisation that holds a DASR 145 approval certificate, the form is to be validated by the organisations quality manager and supporting records retained.
Where the applicant is not employed by an organisation that holds a DASR 145 approval certificate, the form is to be validated by DASA DAVCOMP 66 staff and all supporting records are to be attached with the application.
This DASR Form 19 is the official DASR form to apply for a Military Aircraft Maintenance License (MAML) under DASR 66.
Completion of Application All form fields are to be accurately completed or marked not applicable by the applicant. Where the form is incomplete DASA will not process the application and will return it via the applicant email address provided with no further action.
The application form must be completed electronically and submitted using the form workflow properties. Handwritten and scanned copies of the form will not be processed if received.
Evidence Standard Any records provided to support this application must be certified true and correct by a person that meets the qualification requirements outlined in Schedule 2 of the Commonwealth Statutory Declarations Regulation of 1993.
Where evidence is provided that has not been previously recognised or approved, it is the applicants responsibility to ensure a copy of the relevant procedure or process and objective evidence records are provided to DASA for assessment.
Processes, procedures and records generated will only be considered by DASR assessment staff when:
They form part of an Aviation State Safety Program regulation recognised by DASR and records have been issuedby the regulatory organisation.
They form part of the quality system of an organisation that holds a continuing airworthiness regulatory approvalunder a state safety program and records have been issued by an organisation that holds a current approvalcertificate (M,145), and is the current employer of the applicant.
They form part of the quality system of an organisation that holds a Maintenance Training regulatory approval underan aviation state safety program, or Nationally Recognised Competency based training program and records havebeen issued by an organisation that holds a current approval certificate (Part 147, RTO). Any records issued muststate the approval they have been issued under that relates to their approval certificate.
Withdrawal of Application An application can be withdrawn in writing at any time.
DASR Form 19 V6.0 Template ID: U6906120 Page 1 of 6

Application for Issue/Amendment of DASR 66 Military Aircraft Maintenance Licence
DASR Form 19
SECTION 1 - Applicants Personal Information
Applicant Defence Aviation Reference No Y N DARN-P-
Applicant PMKeyS No (Cur or Ex Serv) Y N PMKeyS
Title Surname
Firstname Middle Name
Nationality Country of Birth
DOB Town of Birth
Section 2 - Applicant Contact Details
Home Address
Town or Suburb
State Post code Country
Email:
Work Phone Mobile Phone
Section 3 - Other Aviation Maintenance Licenses Held
CASA Ref Date of Issue
EASA Ref Date of Issue
Other Date of Issue
Country/State of Issue
Section 4 - Applicant Work Details
Organisation & Entity
Work Venue Address
State Post code Country
Work Venue QM Email
I am a current Employee of a DASR 145 Y N

Application for Issue/Amendment of DASR 66 Military Aircraft Maintenance License
DASR Form 19
Section 5 Application TypeFirst Category Additional Category Aircraft Type rating
Category Exclusion removal Aircraft Type Exclusion removal
Section 6 Basic Category/s Applying for
Aeroplane Turbine A1 B1.1
Helicopter Turbine A3 B1.3
Avionics B2
Base Maintenance C
Section 7 Aircraft Type Rating Applying for
Aircraft type Full or Partial S1000D system coverage Date Complete Certificate No
F P Detail
F P Detail
F P Detail
F P Detail
F P Detail
F P Detail
Please provide any retired or civilian aircraft Types endorsements and dates below
Section 8 Trade and Aviation Qualifications
Qualification Attained Course Detail Date Complete Certificate No
Aviation Technical Training
Aeroskills Cert IV/Diploma
ADF Trade Supervisor Course
ADF Tech Manager Course
Aviation Higher Education

DASR Form 19
Section 9 Aeroskills Competency Units AchievedCore/Common Units
MEA101 MEA103 MEA105 MEA107 MEA108
MEA118 MEA142 MEA148
Avionic Units
MEA279 MEA280
Mechanical Units
MEA343 MEA362 MEA365 MEA366
Other Units
MEA432 MEA433 MEA434 MEA435
List all other PMKeyS proficiencies/Course codes and relevant Units of Competency here

DASR Form 19
Section 10 Recognition Based on Aviation Technical Training Completed I request the following Basic DASA Modules be credited
Note: List the License Category the Module/s applies to, and if the training completed supports a Full or Partial credit against 66 Syllabus. Only request training for assessment where the content is not covered in an Aeroskills Competency unit issued by a approved training organisation.
A1 A3 B1.1 B1.3 B2
Module 1 F P Module 2 F P Module 3 F P Module 4 F P Module 5 F P
Based on Aviation Maintenance Experience I request the following Basic Experience be assessed
Note: Provide Authorisation summary and attach ERTE/RTE/AATTR/PEX reports, Include Journal of industrial experience, or Schedule of experience where applicable. Where recognition for basic modules are sought, outline the program title, training organisation name, and duration of training here.
Off Job Training Post trade training (Skilled Worker/AME) Years / Months
On Job Training Post trade training (Skilled Worker) Years / Months
On Job Exercising A, B1, B2 Line CRS Privileges Years / Months
On Job Exercising B1, B2 Base CRS or Support Staff Privileges Years / Months
Section 11 Declaration I hereby declare that I am the applicant: I have never held an aircraft maintenance license issued under a CASA/EASA/EMAR approval which has been
revoked or suspended. I understand that a person who intentionally provides false or misleading information may be disqualified from
holding a DASR 66 MAML, and I believe that the information in this application is true in every particular.
Date Name/Position Sign I hereby declare that I am a the organisation QM, or am employed in a quality role that reports directly to the QM : All records provided by the applicant meet the requirements of DASR 66 and have been sighted by me and have
been certified true and correct. Copies of records supporting this application are kept on the applicants personal file for verification by DASR
staff.
Date Name 145 Quality Owner Sign
http://www.defence.gov.au/DASP/Docs/Manuals/8000-011/DASRWeb/index.htm#10508.htm#o16059

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afety authority dasr form 19 application for issue ... · pdf fileexisting dasr 66 maml or...

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