DEPARTMENT OF HOMELAND SECURITYU.S. Coast GuardOMB No. 16250040 Exp. Date: 03/31/2021DISCLOSURE STATEMENT FOR NARCOTICS, DWI/DUI, AND/OR OTHER CONVICTIONS (OPTIONAL FORM CG719C) Instructions Who should.
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How to fill out the DHS CG-719C online
Filling out the DHS CG-719C form is an important step for applicants seeking a U.S. Merchant Mariner Credential. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.
Follow the steps to complete the DHS CG-719C online
- Click ‘Get Form’ button to obtain the form and open it in the online editor.
- In Section I: Applicant Information, enter your legal name, including any aliases or maiden names. If you have been previously credentialed by the Coast Guard, provide your reference number, and if you are applying for an original credential, include your Social Security Number and date of birth. If you are under 18, a notarized statement from a legal guardian is required.
- In Section II: Conviction and/or Drug Use Disclosure, provide detailed information regarding any convictions. Include the exact charge(s), city and state/country of conviction, and the date of conviction. Detail the court's findings, including any deferred adjudication or guilty pleas, and provide a summary of the court sentence and requirements.
- Describe what led to your arrest in Section II, including the arresting agency, and confirm compliance with any court orders. If applicable, include information regarding drug use, specifying the type of drug and the month/year of last use.
- In Section III: Acknowledgement and Certification, confirm that you have read and understood the definition of 'conviction' by signing the form and inputting the current date.
- Once you have filled out all sections of the form, you can save any changes, download the form, print it for your records, or share it electronically as needed.
Complete the DHS CG-719C online to ensure a smooth application process.
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Get answers to your most pressing questions about US Legal Forms API.
How do I get a merchant mariner certificate?
Getting a merchant mariner certificate involves completing the necessary training and submitting the DHS CG-719C form along with other required documents. After obtaining your medical certification and passing the tests, submit your application to the Coast Guard. You can streamline this process by utilizing resources from uslegalforms.
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To get a merchant mariner physical, locate a qualified medical professional who is familiar with the DHS CG-719C requirements. Many maritime medical examiners specialize in this area and can be found through online directories. Websites like uslegalforms provide resources to help you identify a suitable examiner near you.
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You can get a drug test for your MMC at various certified facilities, including clinics and laboratories. Look for locations that offer services specifically for maritime credentials; they will be familiar with the DHS CG-719C requirements. Additionally, uslegalforms can help you find providers that meet the necessary standards.
How to obtain a Merchant Mariner Credential?
To obtain a Merchant Mariner Credential, you must complete an application and submit the DHS CG-719C form. It's important to gather all necessary documents, including proof of citizenship and your medical examination results. You can also visit regulatory websites or platforms like uslegalforms for guidance to ensure a smooth application process.
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How to fill out a medical consent form?
To complete a medical consent form, start with your personal and insurance information. Make sure to clearly describe the procedure or treatment you are consenting to, alongside the risks involved. Finally, remember to sign and date the form to comply with legal standards such as the DHS CG-719C.
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Filling out a community service form begins with your contact information and the organization you are volunteering with. Next, specify the type of service and hours you plan to contribute. Always check for any additional instructions related to your entry, especially those that may relate to requirements like the DHS CG-719C.
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