Annex A: Request for Technical Airworthiness Function Waiver Form

Name: Block A

Unit/Company: Block B

POC: Block C

POC Phone/Cell:  Block D

1. Level of authorization sought:  Block E
   • POM
   • SCA
   • ACA
   • ARA
2. Specific MPM references and reason for request: Block F
3. Summary of Previous Aviation Background and Experience: Block G
4. Previous Aircraft Qualifications: Block H
5. Previous Aircraft Authorizations: Block I
6. I certify that all information provided above is true and that all supporting documentation shall be produced on request. 
   • Applicant's Signature and Date: Block J
7. Plan for overcoming definciency: Block K
8. I certify that I have reviewed this applicant’s records and that the plan above will be carried out. I recommend that this waiver be granted. 
   • SMM's Signature and Date: Block L
9. The requested waiver is: (check one)
   • Accepted
   • Denied: Block M
   • TAA's Signature and Date Block N

Instructions for completing the Request for Technical Airworthiness Function Waiver Form

Block A: Identify the individual for whom the waiver is requested.

Block B: Identify the organization making the waiver request.

Block C: Name the Point of Contact (usually, the SMM or PRAA).

Block D: Provide phone for the Point of Contact.

Block E: Identify the authorization level being sought.

Block F: Clearly identify why the waiver is required, as well as the TAM and Organization’s policy manual requirements. If referencing a document, ensure to state the document revision being used.

Block G: Identify individual’s relevant background and experience.

Note: Do not use abbreviations. This block should be accompanied by the individual’s résumé and any applicable artifacts (in attachment).

Block H: Identify specific past training, examinations, and experience that makes the candidate eligible for the authorization sought. Ensure it is written without abbreviations and clearly understandable, especially if training and qualifications were gained outside of Canada, as training in other countries is often unknown. Explain the equivalency of qualifications to Transport Canada or Canadian Military qualifications. This block should be accompanied by supporting diplomas, certificates and course descriptions, as required.

Block I: List all previous authorizations the candidate has held. Ensure they are easily understandable and do not use abbreviations. If previous authorizations were from outside Canada, explain the equivalency to Transport Canada or Canadian Military authorizations. Authorization records should be provided, as applicable.

Block J: Insert individual’s signature to certify that all information provided above is true and that all supporting documentation shall be produced on request.

Block K: Identify the organization’s plan for overcoming the candidate’s requirement gaps. You must also include the maintenance tasks/minimum time that the candidate will be required to fulfill prior to becoming eligible for the authority sought. Also address any specific training to be carried out. It is acceptable to refer to a specific section of agreed-upon policy (e.g., a specific section in an airworthiness implementation plan.) If referring to a document, ensure to state the revision of the document being referenced and provide a copy, if applicable.

Block L: Insert Senior Maintenance Manager’s signature to certify that all information provided above is true and has been reviewed. The organization’s plan in block K will be carried out. The SMM’s signature also certifies that the plan in block K is sufficient in overcoming the candidate’s gaps and, as such, the recommendation for the individual to be granted the certification authority sought without compromising the required level of safety.

Block M: This block will be filled out by the TAA, or TAA-authorized individual, and will indicate if the waiver is accepted or denied.

Block N: This block is signed by the TAA, or TAA-authorized individual who reviewed this form and any accompanying documentation in determining the acceptance or denial of the waiver, as indicated in block M. The acceptance by the TAA or authorized delegate means that the validation and specific mitigation plan conducted by the PRAA and certified by the SMM demonstrated that the intent of the TAM requirements have been met through formal training, OJT, or previous experience on similar aircraft types, or a combination thereof.