EEntry - ntry - LLevel MMD evel MMD WW i i z a r dz a r d
U. S. Coast GuardU. S. Coast Guard
Mariner Licensing & DocumentationMariner Licensing & Documentation
Entry-Level MMD Wizard was designed to assist mariners and licensing professionals with making application for an Entry Level Merchant Mariners Document (MMD).
This Wizard does not assist with the issuance or renewal of the Transportation Worker Identification Credential (TWIC).
The Transportation Security Administration (TSA) is the responsible agency for the issuance and renewal of the TWIC. Please access www.tsa.gov/twic for the latest info regarding the TWIC.
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Instructions...Instructions...
Applicable law supersedes all information contained herein…
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USCG Credential IssuedUSCG Credential Issued
Complete & Accurate Application
Proper User Fees
Original Proof of Citizenship or Nationality
2 Passport Photos & Camera Set-up Form
Complete & Accurate Certification of Fitness
Acceptable (negative) Drug Test
Original Proof of Identity & SSN
Safety & Security Background Clearance
Fingerprinted by REC PersonnelReturn to Applicant
Overview...Overview...
Getting StartedGetting Started
46 United States Code Annotated (U.S.C.A.), Title 46—Shipping.
Code of Federal Regulations (CFR), Title 46, Parts 1 to 40—Shipping.
Marine Safety Manual (MSM), Volume III, Marine Industry Personnel, COMDTINST M16000.8 (Series).
Applicable Navigation and Vessel Inspection Circulars (NVICs).
Applicable USCG Policy Letters & Guidance Documents.
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You may apply in person at any Regional Examination Center (REC).
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Where to Apply...Where to Apply...
AnchorageUSCG REC Anchorage
800 E. Diamond Blvd, Suite 3-227
Anchorage, AK 99515(907) 271-6736
(907) 271-6742 (Fax)[email protected]
Guam (Monitoring Unit)USCG REC GuamPSC 455, Box 176
FPO AP, Guam 96570-1056(671) 339-2001, Ext 153
(671) 339-2005 (Fax)[email protected]
Ketchikan (Monitoring Unit)USCG REC Ketchikan
1621 Tongass Avenue, Suite 202
Ketchikan, AK 99901(907) 225-4496
(907) 225-4499 (Fax)[email protected]
BaltimoreUSCG REC Baltimore
40 South Gay Street, Room 420Baltimore, MD 21202-4022
(410) 962-5132/5147(410) 962-0930 (Fax)
HonoluluUSCG REC Honolulu433 Ala Moana Blvd
Honolulu, HI 96813-4909(808) 522-8264
(808) 522-8277 (Fax)
Long BeachUSCG REC Long Beach
501 West Ocean Blvd, Suite 6200
Long Beach, CA 90802(562) 495-1480
(562) 435-1050 (Fax)
BostonUSCG REC Boston
455 Commercial StreetBoston, MA 02109-1045
(617) 223-3040(617) 223-3034 (Fax)
HoustonUSCG REC Houston
8876 Gulf Freeway, Suite 200Houston, TX 77017-6595
(713) 948-3350(713) 948-3360 (Fax)
[email protected]@uscg.mil
MemphisUSCG REC Memphis
200 Jefferson Avenue, Suite 1302
Memphis, TN 38103-2300(901) 544-3297
(866) 777-2784 (Toll Free)(901) 544-3372 (Fax)
CharlestonUSCG REC Charleston
196 Tradd StreetCharleston, SC 29401-1800
(843) 720-3250(800) 826-1511 (Toll Free)
(843) 720-3259 (Fax)
JuneauUSCG REC Juneau
2760 Sherwood Lane, Suite 2AJuneau, AK 99801-8545
(907) 463-2458(907) 463-2445 (Fax)
MiamiUSCG REC Miami
Claude Pepper Federal Building51 S.W. 1st Avenue, 6th Floor
Miami, FL 33130-1608(305) 536-6548/6549/6874(800) 982-9374 (Toll Free)
(800) 536-4304 (Fax)
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List of RECs (A-M)...List of RECs (A-M)...
New OrleansUSCG REC New Orleans
4250 Highway 22, Suite FMandeville, LA 70471
(985) 624-5700(985) 624-5757 (Fax)
San Francisco BayUSCG REC San Francisco BayOakland Federal Bldg, North
Tower1301 Clay Street, Room 180N
Oakland, CA 94612-5200(510) 637-1124
(510) 637-1126 (Fax)[email protected]
ToledoUSCG REC Toledo
420 Madison Ave, Suite 700Toledo, OH 43604
(419) 418-6010(419) 259-7558 (Fax)
New YorkUSCG REC New YorkBattery Park Building
1 South StreetNew York, NY 10004-1466
(212) 668-7492(212) 668-6394 (Fax)
San Juan (Monitoring Unit)USCG REC San Juan5 Calle La Puntilla
San Juan, PR 00901(787) 729-2376
(787) 729-2364 (Fax)
National Maritime Center Detachment
150 East Burr Blvd, Top FloorKearneysville, WV 25430
(304) 728-9100(304) 728-7373 / 7332 (Fax)
Puget Sound (Seattle)USCG REC Seattle
Jackson Federal Building915 Second Ave, Room 194
Seattle, WA 98174-1067(206) 220-7327
(206) 220-7329 (Fax)
PortlandUSCG REC Portland
6767 North Basin AvenuePortland, OR 97217-3992
(503) 240-9346(503) 240-9345 (Fax)
St. LouisUSCG REC St. Louis
1222 Spruce Street, Suite 8.104E
St. Louis, MO 63103-2835(314) 539-3091
(314) 539-2659 (Fax)
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List of RECs (N-Z)...List of RECs (N-Z)...
Getting StartedGetting Started
Forms & Reference Number
Application CG-719B (Rev 03/04)
Physical CG-719K (Rev 03/04)
Fitness Cert. for Entry Level Ratings CG-719K/E (Rev 03/04)
Drug Test CG-719P (Rev 03/04)
Acceptable ID MLD-FM-REC-105 (03)
MID Scanner Image Form FM-REC-102 (01)
Credit Card Authorization MLD-FM-REC-100 (01)
Drug Policy NMC GD 03-04
Drug Test Instructions FM-REC-101 (01)
Physical Standards NVIC 02-98
Sample Statement of Convictions N/A
Mariner Survey FM-REC-08 (02)
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Forms and Reference...Forms and Reference...
Getting StartedGetting Started
Web Link Description
http://www.uscg.mil/stcw/home.htm USCG Licensing Website
http://www.gpoaccess.gov/uscode/index.html USCA Online
http://www.gpoaccess.gov/cfr/index.html CFR Online
http://www.uscg.mil/hq/g-m/nmc/pubs/msm/vol3.htm Marine Safety Manual (MSM), Vol III
http://www.uscg.mil/hq/g-m/nvic/index90.htm NVICs
http://www.uscg.mil/STCW/mmic-policy.htm NMC Policy & Guidance
http://www.uscg.mil/hq/g-m/nmc/web/ NMCs Website
http://www.uscg.mil/STCW/mmic-appcourses.htm Approved Courses
http://workplace.samhsa.gov/DrugTesting/Level_1_Pages/CertifiedLabs.aspx
SAMHSA Drug Lab List
www.uscg.mil/hq/g-m/moa/dapip.htm Drug Service Agents
https://www.pay.gov/paygov Pay User Fees Online
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Web Links...Web Links...
Getting StartedGetting Started
This Wizard was designed for mariners and licensing professionals as an interactive step-by-step instructional tool for entry-level MMD credentials.
Entry-Level MMD Wizard, Version 1.1 (09/13/2007).
Entry-Level MMD Wizard can be burned on CDs and downloaded via the world wide web.
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About...About...
ApplicationApplication
Incomplete and inaccurate information reported on the application will cause significant delays.
False statements are grounds for denial of the application as well as criminal prosecution & financial penalty.
An approved application is valid for 12 months.
All transactions require an original application.
Use the sub-menu link to view or print the application and other documents.
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General
Section I
Section II
Section III
Section IV
Section V
Section VI
Sections VII through IX
View / Print Application Form
View / Print Sample Statement
General...General...
This section contains important personal data. Fill in each block, or write N/A for not applicable.
ApplicationApplication
By law, the next of kin information is required.
When your credential is issued by mail, the address in this section is used. Please make sure it is accurate and report changes immediately.
If you are under 18, check here & provide a notarized statement of parental or guardian consent.
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Section I
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View / Print Application Form
View / Print Sample Statement
Section I...Section I...
ApplicationApplication
Place check marks for an Original Merchant Mariner’s Document (MMD).
In the applying for box, write or type “Entry-Level MMD”.
Write or type “N/A” in the Current or Previous License or MMD section.
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Sections VII through IX
View / Print Application Form
View / Print Sample Statement
Section II...Section II...
Entry-Level MMD.
N/A N/A N/A
ApplicationApplication
Conviction means found guilty (felony or misdemeanor) by judgment or by plea and includes cases of deferred adjudication (no contest, adjudication withheld, etc.) OR where the court required you to attend classes, make contribution of time or money, receive treatment, submit to any manner of probation or supervision, or forgo appeal of a trial court finding. Expunged convictions must be reported unless the expungement was based upon a showing that the court’s earlier conviction was in error.
Page 1 of 3
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Section I
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Sections VII through IX
View / Print Application Form
View / Print Sample Statement
Section III (1 of 3)...Section III (1 of 3)...
ApplicationApplication
Attach a statement for all areas marked yes.
““On January 1, 2000, I was arrested for DUI . On February 5, 2000, I plead guilty to DUI On January 1, 2000, I was arrested for DUI . On February 5, 2000, I plead guilty to DUI in League City, TX. My license was suspended for 6 months, I paid a $2,000 fine, and I in League City, TX. My license was suspended for 6 months, I paid a $2,000 fine, and I attended a defensive driving course. On June 16, 2000, I completed all court requirements attended a defensive driving course. On June 16, 2000, I completed all court requirements and my DL was reinstated. I apologize for my actions and request favorable consideration and my DL was reinstated. I apologize for my actions and request favorable consideration on my application. I no longer drink and drive” on my application. I no longer drink and drive”
At a minimum, the statement must include, when, where & what happened. The statement must be signed and dated.
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View / Print Application Form
View / Print Sample Statement
Section III (2 of 3)...Section III (2 of 3)...
ApplicationApplication
The 7 questions in this section start with “Have you ever…” Therefore, regardless of how long ago a conviction occurred, it must be reported each time an application is submitted.
Answer each question by placing a check mark in the appropriate box.
You must attach a statement of explanation for all areas marked yes.
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Section I
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Sections VII through IX
View / Print Application Form
View / Print Sample Statement
Section III (3 of 3)...Section III (3 of 3)...
When you sign & date the application, you are certifying that the information is true and correct. False statements are grounds for denial as well as criminal & financial penalty…
Sign Here (Mandatory) Date
ApplicationApplication
Section IV is for original license applicants only and does not apply to entry-level MMDs.
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Section I
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Sections VII through IX
View / Print Application Form
View / Print Sample Statement
Section IV...Section IV...
ApplicationApplication
Read the National Driver Registry (NDR) consent authorization carefully.
Sign and date to authorize the NDR search. Your consent authorization is mandatory.
The Mariner’s Tracking System is optional. If you want to participate, you must sign and date these boxes.
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Sections VII through IX
View / Print Application Form
View / Print Sample Statement
Section V...Section V...
Sign Here (Mandatory) Date
Sign Here (Optional) Date
ApplicationApplication
Read the Certification carefully.
Sign and date certifying that the information is true and correct.
The oath is required, but must be witnessed by a Coast Guard Official. Please leave this blank until you make application in-person.
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Sections VII through IX
View / Print Application Form
View / Print Sample Statement
Section VI...Section VI...
Sign Here (Mandatory) Date
ApplicationApplication
Sections VII through IX are for U. S. Coast Guard use only. Do not fill out these boxes.
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Sections VII through IX
View / Print Application Form
View / Print Sample Statement
Sections VII through IX...Sections VII through IX...
FeesFees
You can pay by check, money order, credit card, debit card, and some RECs accept cash.
Use the sub-menu link to view or print the credit or debit card authorization form.
You can pay on-line at https://www.pay.gov/paygov. Print your receipt and include it with your application.
Make checks and money orders payable to the U. S. Coast Guard. Include your SSN in the memo area.
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Fee Chart
Credit Card Authorization Form
General...General...
Transaction Amount
Evaluation Fee for Original Entry Level Rating MMD $95.00
Issuance Fee for Original Entry Level Rating MMD $45.00
Total Fees Due: $140.00
FeesFees
It is highly recommended that you pay both the evaluation fee and the issuance fee when you make application.
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Fee Chart
Credit Card Authorization Form
Fee Chart...Fee Chart...
Citizenship and NationalityCitizenship and Nationality
U.S. Citizens:
Original proof of citizenship is required.
Nationality of Aliens:
Original proof of nationality is required. Aliens must also provide evidence from the U.S. Citizenship and Immigration Services that he/she is lawfully admitted to the U.S. for permanent residence. Evidence may be in the form of an alien registration receipt card issued by the U.S. Citizenship and Immigration Services bearing the certification that the alien was admitted to the U.S. as an immigrant, or a declaration of intention to become a citizen of the U.S. issued
by a naturalization court.
Use the sub-menu link to view the acceptable identification and citizenship documents. Make sure you read the foot notes at the bottom of the document.
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Requirements
Acceptable Citizenship / ID
Requirements...Requirements...
IdentityIdentity
Applicants shall present acceptable proof of identity.
Use the sub-menu link to view the acceptable identification and citizenship documents. Make sure you read the foot notes at the bottom of the document.
Original social security card (SSC) is required for all applicants.
Proof of identity shall consist of two current forms of identification, one of which shall contain a photo of the applicant. Proof of citizenship or nationality may be acceptable as one of the ID documents.
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Requirements
Acceptable Citizenship / ID
Requirements...Requirements...
FingerprintsFingerprints
Fingerprints are required, and they must be taken by REC personnel. Fingerprints from other agencies are no longer accepted.
Please be aware, the Safety & Security background checks require fingerprints. Therefore, without your fingerprints, your application will be delayed.
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Requirements
Requirements...Requirements...
Passport PhotosPassport Photos
2 passport photos are required for entry-level MMDs.
You must also sign the Mariner Identification System Scanner Image Capture Form and submit it with your application. Sign in the middle of the box without touching the lines.
Use the sub-menu link to view or print the Mariner Identification System Scanner Image Capture Form.
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General
View / Print Camera Form
General...General...
Certification of FitnessCertification of Fitness
All entry-level MMD transactions require certification of fitness.
Incomplete, inaccurate, and/or missing information will cause significant delays.
Prior to leaving your doctor’s office, take a few minutes to review your certification of fitness for completeness.
The certification of fitness must be dated within 1 year of the application date.
Use the sub-menu link to view or print the certification of fitness form or NVIC 02-98.
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Instructions
Section I
Section II
Section III
Section IV
Section V
Medical Waivers
View / Print Cert. Of Fitness Form
View / Print NVIC 02-98
General...General...
Certification of FitnessCertification of Fitness
This presentation focuses on the Merchant Marine Certification of Fitness for Entry Level Ratings, CG-719K/E.
The Merchant Mariner Physical Examination Report, CG-719K may also be used to satisfy the requirements, but is much more detailed.
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View / Print Cert. Of Fitness Form
View / Print NVIC 02-98
Instructions...Instructions...
Certification of FitnessCertification of Fitness
These blocks are self explanatory, however they must be complete.
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Medical Waivers
View / Print Cert. Of Fitness Form
View / Print NVIC 02-98
Section I...Section I...
SMITH, JOSEPH, WILLIAM XXX-XX-XXXX
Certification of FitnessCertification of Fitness
These blocks are self explanatory, however they must be complete.
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View / Print Cert. Of Fitness Form
View / Print NVIC 02-98
Section II...Section II...
5 10 GREEN
165 BROWN
TATOO ON LEFT UPPER ARM
Certification of FitnessCertification of Fitness
This section requires your full attention.
Prior to leaving your doctor’s office, ensure that all the blocks have been filled out.
Entries must be specific and legible.
The next few slides break this section down for easier understanding.
Page 1 of 3
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Medical Waivers
View / Print Cert. Of Fitness Form
View / Print NVIC 02-98
Section III (1 of 3)...Section III (1 of 3)...
Certification of FitnessCertification of Fitness
The list of requirements.
Applicant does not have the physical strength, agility, and flexibility, not competent, OR needing further review are considered disqualifying.
Page 2 of 3
If the applicant can perform all the items listed and is considered competent, the following blocks must be marked with an “X”.
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View / Print Cert. Of Fitness Form
View / Print NVIC 02-98
Section III (2 of 3)...Section III (2 of 3)...
Certification of FitnessCertification of Fitness
Page 3 of 3
Name, license, telephone, and address of physician are required.
The certification of fitness must be signed and dated by your doctor.
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View / Print Cert. Of Fitness Form
View / Print NVIC 02-98
Section III (3 of 3)...Section III (3 of 3)...
Physician Signs Here (Mandatory) Date
Certification of FitnessCertification of Fitness
You must sign and date the certification of fitness certifying the information is complete and true.
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Medical Waivers
View / Print Cert. Of Fitness Form
View / Print NVIC 02-98
Section IV...Section IV...
Mariner Signs Here (Mandatory) Date
Certification of FitnessCertification of Fitness
This section contains a detailed description of the requirements, but nothing is required to be filled out or signed.
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Section I
Section II
Section III
Section IV
Section V
Medical Waivers
View / Print Cert. Of Fitness Form
View / Print NVIC 02-98
Section V...Section V...
Certification of FitnessCertification of Fitness
The below listed medical conditions may need further review. If supporting documentation is requested by the NMC or REC, these checklists may be helpful.
Cardiac ConditionsDiabetes
General Conditions (Not Addressed Above)
HearingPhysical HandicapsPsychotropic DrugsVision
Waivers are considered on a case by case basis.
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Section I
Section II
Section III
Section IV
Section V
Medical Waivers
View / Print Cert. Of Fitness Form
View / Print NVIC 02-98
Medical Waivers...Medical Waivers...
Drug TestDrug Test
A drug test is required for all original entry-level rating MMD transactions.
Only a DOT 5 panel test via a SAMHSA lab will be accepted.
There are 3 options available to satisfy the drug testing requirements.
Use the sub-menu link to view or print the periodic drug test form, NMC GD 03-04 for additional instructions.
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Option 1 (Periodic Testing)
Option 2 (Random Testing)
Option 3 (Pre-Employment Testing)
Periodic Drug Test Form
NMC GD 03-04
Additional Drug Test Instructions
General...General...
Drug TestDrug Test
A USCG drug testing conducted within the past six months in accordance with the procedures established in 49 CFR, part 40, and the USCG.
Make sure that the testing laboratory is on the SAMHSA laboratory list which can be obtained at http://workplace.samhsa.gov/DrugTesting/Level_1_Pages/CertifiedLabs.aspx.
A list of service agents that can assist in meeting these requirements can be obtained at www.uscg.mil/hq/g-m/moa/dapip.htm.
Use the sub-menu link to view or print the periodic drug test form.
Make sure the drug testing Custody and Control Form (CCF) has the word “Federal” in the form header.
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Option 1 (Periodic Testing)
Option 2 (Random Testing)
Option 3 (Pre-Employment Testing)
Periodic Drug Test Form
NMC GD 03-04
Additional Drug Test Instructions
Option 1 (Periodic Testing)...Option 1 (Periodic Testing)...
Drug TestDrug Test
An original dated letter on marine employer stationary or, for active duty military members, an original dated letter from your command on command letterhead attesting to participation in a random drug testing program.
Example (From Marine Employer):
Applicant’s Name / SSN has been subject to a random drug testing program meeting the criteria of Title 46 CFR 16.230 for at least 60 days during the previous 185 days and has not failed nor refused to participate in a chemical test for dangerous drugs.
Example (Active Duty Military/Military Sealift Command/NOAA/Army Corps of Engineers):
Applicant’s Name / SSN has been subject to a random drug testing program and has never refused to participate in or failed a chemical test for dangerous drugs.
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Option 1 (Periodic Testing)
Option 2 (Random Testing)
Option 3 (Pre-Employment Testing)
Periodic Drug Test Form
NMC GD 03-04
Additional Drug Test Instructions
Option 2 (Random Testing)...Option 2 (Random Testing)...
Drug TestDrug Test
An original dated letter on marine employer stationary signed by a company official, stating that you have passed a pre-employment chemical test for dangerous drugs within the past six months.Example:
Applicant’s Name / SSN passed a chemical test for dangerous drugs, required under Title 46 CFR 16.210 within the previous six months of the date of this letter with no subsequent positive drug test results during the remainder of the six month period.
The letter must also include:
Name & Address of SAMHSA lab.
Name & Address of the DOT qualified MRO.
MRO Organization.
Registration Number.
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Option 1 (Periodic Testing)
Option 2 (Random Testing)
Option 3 (Pre-Employment Testing)
Periodic Drug Test Form
NMC GD 03-04
Additional Drug Test Instructions
Option 3 (Pre-Employment Testing)...Option 3 (Pre-Employment Testing)...
ChecklistChecklist
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Checklist (1 of 4)...Checklist (1 of 4)...
USCG Credential IssuedUSCG Credential Issued
Complete & Accurate Application
Proper User Fees
Original Proof of Citizenship or Nationality
2 Passport Photos & Camera Set-up Form
Complete & Accurate Certification of Fitness
Acceptable (negative) Drug Test
Original Proof of Identity & SSN
Safety & Security Background Clearance
Fingerprinted by REC PersonnelReturn to Applicant
ChecklistChecklist
Application:
Sect I: Ensure your mailing address is correct.
Sect II: Write “Entry-level MMD” in the applying for box.
Sect III: Read the definition of conviction & answer the questions honestly. Sect III: Write a statement for all “yes” answers (when, where & what).
Sect III: Sign & Date attesting that your answers are truthful. Sect V: Sign and Date the NDR consent. Sect VI: Sign and Date certifying the application is true and correct.
Fees: Include $140.00 with your application. You can pay by check; money order, credit/debit card, pay.gov, & some RECs accept cash.
Page 2 of 4
Sect I: Verify that every block is filled out, or write “N/A”.
Sect I: Next of kin name, address and relationship is required by law.
Sect III: Provide court documentation for recent convictions (5 years).
Use the sub-menu link to print the checklist.
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Checklist (2 of 4)...Checklist (2 of 4)...
ChecklistChecklist
Identity: Two current forms of identification are required, one of which shall contain a photo of the applicant.
Fingerprints: Fingerprints are required, and they must be taken by REC personnel.
Page 3 of 4
Original social security card is required for all applicants.
Citizenship & Nationality: For U.S. Citizens: Original proof of citizenship required. For Aliens: Original proof of nationality & evidence of lawful admittance to U.S. for permanent residence required.
Sign the camera form & include it with your package. Two passport photos required.Passport Photos:
Use the sub-menu link to print the checklist.
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Checklist (3 of 4)...Checklist (3 of 4)...
ChecklistChecklist
Page 4 of 4
Drug Test: Periodic: MRO signed the document. Periodic: Document is original; photocopies are unacceptable. Random & Pre-employment: Original company letter meets requirements.
Delivery of Application Package: Bring your completed application and associated documentation to a REC in-person.
Include a completed checklist with your application package.
Certification of Fitness: Verify that every block is filled out properly. Section III: Ensure all the physician contact information is filled out, and ensure that your physician signed and dated the form. Section IV: Sign and date, certifying the information is true.
Use the sub-menu link to print the checklist.
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Checklist (4 of 4)...Checklist (4 of 4)...
The EndThe End
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