Application Check Sheet

IMPORTANT: Before you mail or submit your application, please review the following
to prevent delays.

[ ] Completed Application,- Oath signature notarized. Application has been prepared in ink or typewritten. All appropriate blanks have been completed in accordance with instruction sheet.

[ ] Proof of Citizenship- Enclosed a notarized copy of Birth Certificate, passport, or certificate of Baptismal recorded within one year of birth. Resident Aliens must present a notarized copy INS
Permanent Resident Alien card (Green Card). (For original application only).

[ ] Notarized copy of Social Security Card, W 2-form or Social Security Administration verification of number.
(For original application only).

[ ] 3 Character References- 3 letters attesting to your character from individuals not related to you. (For original licenses applications only)

[ ] Completed Physical Exam - a complete physical taken within one year of date of application. Physical must be signed by physician and if you wear corrective lenses, must include both uncorrected and corrected vision.

[ ] Chemical Drug Test - a drug screen performed by an approved lab, and certified negative by a medical review officer. Only original forms are acceptable, and must contained the signature of the
medical review officer.

[ ] First Aid/CPR - Enclosed notarized copies of the front and back of course certificates (cards). First Aid courses must be completed within the past 1 2 months, CPR certificates of completion must
be valid.

[ ] Sea Service discharges, forms or letters- Sea service forms have signed and or notarized with owners signature. For service on your own vessels, ensure photocopies of proof of ownership of the
vessels are included. Recency requirement of 90 days of underway sea service within the last 3 years.

[ ] Fingerprint Cards (Two Cards) - Two cards have been included according to instructions originals only). Prints may be taken by Coast Guard official, local law enforcement agency, or Coast Guard approved course facility representative. (Original licenses & document applications only)

[ ] Applicable user Fees - A check or money order is enclosed made payable to U. S Coast Guard, with Social
Security number and home address included.

[ ] Age requirements: Must be 18 years old for OUPV, and 19 for all other deck licenses; 18 for DDE 1000 hp,
19 for DDE 4000 and Assistant Eng. (limited oceans), and 21 for DDE Unlimited

[ ] Make copies of your package for your files.