Instructions for Completing the Application:

Read all instructions on the application form carefully. If the application form is not completed properly, It will be returned to you for corrections which may cause delays. Print or type all information on the form with the exception of your signature and initials where Indicated. Enter all information in full: do not use abbreviations. If a block or section does not apply to you, place N/A in it. Be sure to read the Privacy Act Statement.

Section 1 (Blocks l-19): Block 1 is in the upper right hand corner. Enter the name of the Regional Examination Center you are sending the application to. Blocks 2-9 are self-explanatory. In block 10, check the type of transaction requested either licenses or Merchant Mariner document. (You may apply for more than one transaction on a single application form). Next check the applicable block for an original license, renewal original document, etc.

Section II (Blocks 20-25): Complete these blocks as necessary. IMPORTANT- You must place your Initials In answer to block 24.

Section III (Blocks 27-35): These blocks are self-explanatory. Enter UN/AN for all blocks that do not pertain to you.

Section IV (Block 36): This section applies to original license only. Indicate whether letters of reference are attached.

Section V (Blocks 3742): These blocks are only for applicants filing for duplicate license, Merchant Mariner document or continuous discharge book.

Section VI Narcotics DWI/DUI and Conviction Record. These blocks are self-explanatory. IMPORTANT- You must place your initials in either the yes or no block for each question. If you answer "yes" to any of the questions, you must attach a statement explaining in full the circumstances pertaining to each charge along with the disposition of the charge.

Section VII (Blocks 4344): Sign and date the form in the appropriate blocks. The seaman's Oath must be administered by Coast Guard licensing official or a Notary Public. If signed before a Notary Public the Notary's seal and signature must be affixed.
Section IX: Read and sign both sections. IMPORTANT - Refusal to sign the National Driver Registry consent form could preclude you from receiving a license. The signature for the Mariner's Tracking System is purely voluntary. If you do not wish to participate, do not sign that block.