The South Dakota A 94 A form is a Private Aerial Applicator Application that must be submitted alongside the Private Pesticide Applicator License Application. This form collects essential information regarding the applicant's qualifications, including pilot certifications and flight experience. For those interested in aerial pesticide application, completing this form is a crucial step in obtaining the necessary licensing.
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The South Dakota A 94 A form serves as a critical document for individuals seeking to obtain a Private Aerial Applicator License in the state. This form is submitted alongside the Private Pesticide Applicator License Application, establishing the applicant's qualifications and experience in aerial pesticide application. Key sections of the form require detailed personal information, including the applicant's name, address, and contact details, as well as information about their business or employer. Crucial to the application process is the inclusion of the applicant's Federal Airman’s Certification number and the Agricultural Aircraft Operator’s FAA Certificate number, which validate their credentials. The form also necessitates a comprehensive account of the applicant's flying experience, detailing total flight hours and specific hours logged in different aircraft types. Additionally, applicants must disclose their experience with aerial spraying, including the number of acres treated in South Dakota within the past year. For those with less than 750 Pilot In Command hours, the form mandates supervision by a licensed FAA Part 137 pilot, ensuring safety and compliance with regulatory standards. Lastly, applicants must confirm their history concerning any previous denials to spray in other states, underscoring the importance of transparency in the licensing process. Overall, the A 94 A form is a vital tool for regulating aerial pesticide application and ensuring that practitioners meet the necessary safety and competency standards.
Division of Agricultural Services
Foss Bldg, 523 E Capitol Ave
Pierre, SD 57501-3182
Phone: (605) 773-4432
Fax: (605) 773-3481
Web: sdda.sd.gov/Ag_Services
Form A 94 A
PRIVATE AERIAL APPLICATOR APPLICATION
(To be submitted with the P r i v a t e
Pesticide Applicator License Application)
Name:
First
Middle Initial
Last
Address:
Street or Box
City
State
Zip+4
Phone No.
Business Name or Employer:
Email Address:
1.
Federal Airman’s Certification number:
Rating:
2.
Agricultural Aircraft Operator’s FAA Certificate
number & Date issued:
3.Will cover: (List each aircraft below)
Make
Model
Year
Federal ‘N’ No. (required)
South Dakota Reg. No.
(contact SD DOT to pay fee 605-773-4430)
4.Has listed aircraft (including attached equipment) received FAA approval?
5.a. Total Pilot In Command (PIC) flight hours
b. Total (PIC) Hours: Single Engine-Tricycle Gear:
; Single engine-Conventional/Trail Dragger:
;
Helicopter:
; Other:
6.In reference to 5b, number of hours within the preceding 12 months by type.
7.
a. Total hours of spraying and/or dusting experience:
Within past year:
b. Equivalent hours of experience within the past year (e.g. Practice time).
______________
c. Have you successfully completed an FAA approved aerial applicator school? __________________________________
If so, please attach a copy if this is the first time application.
8.a. Number of acres in South Dakota, treated by the applicant within the past year. b. Number of flight hours involved in the treatment of the acreage in 8a.
9.Anyone who has less than 750 PIC Hours and has not previously sprayed under a Class B permit for 2 years or successfully completed an FAA approved aerial applicators school or have a current aerial applicators license from another state, must operate under the supervision of a SD licensed FAA Part 137 license holder.
Name of supervisor pilot
Signature
(Print)
10. Have you or any employer (for which you have ever worked) been denied permission to spray in any state? If yes, indicate employer, company, year of denial and state where denial was issued.
11.The information provided above is true and correct, to the best of my knowledge.
Date
OFFICE USE ONLY
APPROVED BY THE SOUTH DAKOTA AERONAUTICS COMMISSION
Program
Class
Manager
Revised 04/2012
South Dakota Unemployment Employer Registration - The application aids in safeguarding the rights of employees and ensuring that new owners fairly assume any existing unemployment insurance liabilities.
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