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U.S. DEPARTMENT OF HOMELAND SECURITY U.S. COAST GUARD CG-719K/E Rev. (01-09) Merchant Mariner Evaluation of Fitness for Entry Level Ratings OMB 1625-0040 Expires 6/30/2012 Section I Applicant Information.

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How to fill out the Cg 719k E online

Filling out the Cg 719k E form is a vital step for anyone seeking an entry-level rating in maritime professions. This guide provides clear instructions to assist you in completing the form accurately and efficiently in an online format.

Follow the steps to complete the Cg 719k E form.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor of your choice.
  2. Begin with Section I, where you will provide your personal information. Enter your name in the format of Last, First, and Middle. Include your Social Security Number, age, and date of birth in the specified format (MM/DD/YYYY).
  3. Move to Section II, which covers physical information. Fill in your height, eye color, distinguishing marks, weight, hair color, and body mass index as required.
  4. In Section III, you will certify your physical abilities. Read through the physical tasks listed and confirm your capabilities by placing an X in the relevant box. Ensure to include comments if necessary.
  5. Provide the name and signature of the evaluating physician, physician assistant, or nurse practitioner. Include their license number and office address. Make sure to have the healthcare provider indicate the applicant's competency status.
  6. Lastly, in Section IV, the applicant must sign and date the form, certifying that all provided information is complete and accurate.
  7. Once all sections are complete, save your changes, and you may choose to download, print, or share the completed form as needed.

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Mariners may be disqualified due to multiple reasons, including but not limited to, the following: inadequately controlled diabetes with Hemoglobin A1c levels equal to or greater than 8.0%; episodes of hypoglycemia; documented non-compliance with treatment; significant diabetic retinopathy that causes the mariner not ...

CG 719K/E. The Application for Merchant Mariner Medical Certificate for Entry Level Ratings (CG-719K/E) is required for entry level mariners. The examination and form must be completed within 12 months of application date.

For a medical certificate only, the preferred way to submit your CG-719K or CG-719K/E (medical certificate applications) along with any supplemental medical information is via e-mail to MEDAIP@uscg.mil.

Applicants may submit an application via email, which is the preferred method, to RECLB@uscg.mil, or by fax or mail. Medical applications and supporting medical documentation should be sent via e-mail to MEDAIP@uscg.mil . Please include your full name in the subject line and ensure attachments are in PDF format.

I do solemnly swear or affirm that I will faithfully and honestly, ing to my best skill and judgment, and without concealment and reservation, perform all the duties required of me by the laws of the United States. I will faithfully and honestly carry out the lawful orders of my superior officers aboard a vessel.

This means the certificate is really only good for 18 months. For those of you required by your company to get an annual physical, make sure the medical provider fills out the Coast Guard medical form (CG-719K), and make sure to submit it annually.

Any application for a medical certificate that is submitted with a CG-719B (MMC and medical certificate) must be submitted to an REC. Medical certificate applications can be submitted to the NMC via e-mail at: MEDAIP@uscg.mil.

All Coast Guard issued licenses and documents must be renewed five years from the original date of issuance or last renewal.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232