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SectionI –Applicant Information

CLEAR FORM PRINT FORM. CREDENTIALING SECTION USE ONLY. MIAMI-DADE AVIATION DEPARTMENT. _____. Security Division Credentialing Section BOX 025504, Miami, Florida 33102 Arrival: _____. Terminal D, 3rd Floor Appt. Time: _____. Phone: (305) 876-7188. Conf.: _____. AIRPORT IDENTIFICATION BADGE APPLICATION. ALL AREAS MUST BE TYPED AND COMPLETED UPON SUBMISSION. Signatures by the employee and authorized company representatives will only be accepted using blue ink. Miami-Dade Aviation Department (MDAD) will not accept this form if it is altered (use of correction fluid, torn, folded, bent or otherwise defaced).

Yes No Destruction of an aircraft or aircraft facility Yes No Armed or felony unarmed robbery Yes No Aircraft piracy outside the special aircraft jurisdiction of the United States Yes No Felony involving dishonesty, fraud, or misrepresentation

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