DEPARTMENT OF HOMELAND SECURITY OMB No. 1625-0040 U.S. Coast Guard Exp. Date 03/31/2021 SMALL VESSEL SEA SERVICE FORM OPTIONAL CG-719S For Service on Vessels of Less Than 200 Gross Register Tons Only Section I Applicant Information Note Complete One Form Per Vessel Name Last First Middle Vessel Name Reference Number if applicable Social Security Number Official number s listed on the registration certificate or document Length Feet Vessel Gross Tons Width if known Inches Propulsion Motor/Steam/Gas Turbine/Sail/Aux Sail Depth if known Served As Master/Mate/Operator/Deckhand/Engine etc. Name of Body or Bodies of Water Upon Which Vessel was Underway Geographic Locations Section II Record of Underway Service In the block under the appropriate month write in the number of days you served for that year you can show more than one year January Year February Days May June September March November December Number of days served on Great Lakes Average hours underway per day the boundary line as defined in 46 CFR Part 7 Average distance offshore boundary line as defined in 46 CFR Part 7 Reset August Total number of days served on this vessel CG-719S 04/17 July October April Page 1 of 2 Section III Signature and Verification - Applicant Read Before Signing Owners of vessels may attest to their own experience and provide proof of ownership per 46 CFR 10. 232. Those who do not own their own vessel must obtain letters or other evidence from licensed personnel or the owners of the vessels listed per 46 CFR 10. 232. I certify that I have served on the above vessel as stated* I am making this statement in order that I the applicant may obtain a credential to operate a vessel under the provisions of Title 46 CFR as applicable. I understand that if I make any false or fraudulent statement in this certification of service I may be subject to a fine or imprisonment of up to five 5 years or both 18 U*S*C. 1001. Date MM/DD/YYYY Signature of Applicant x Owner Operator or Master Read Before Signing I certify that the above individual has served on the above vessel as stated* I am making this statement in order that the applicant may obtain a credential to operate a vessel under the provisions of Title 46 CFR as applicable. 1001. Signature and Title of Person Attesting to Experience Last Email Address Optional Street Address City State Zip Code Phone PRIVACY NOTICE Authority 14 U*S*C. 632 46 U*S*C. 2103 7101 7302 7502 46 C. F*R* 10. 301 Purpose The information is collected by the Coast Guard to determine whether an applicant meets the regulatory standards for issuance of a U*S* Merchant Mariner Credential MMC. The Coast Guard evaluates an applicant s qualifications to determine compliance with the national and international requirements for issuance of the MMC any endorsement within the MMC and medical certificate. Routine Uses The information is used by authorized Coast Guard personnel who have a need for the record to determine whether an applicant is a safe and suitable person and qualifies for the MMC any endorsement within the MMC and medical certificate.
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Video instructions and help with filling out and completing small vessel sea service form
Welcome to explorers guy Maritime Academy our application help videos I'm putting together a number of videos on the various parts of your National Maritime Center application we get a lot of calls from our students and others on the application and many people tell me that is actually more stressful to fill out the application there it is to go through and take the courses and exams but in our classroom environment I go through in detail how to fill out these forms so for our online class students as well as others I'm going to go through, and today we're going to talk about the application itself may I suggest that you download the application from our website these are linked to the National Maritime Center so that you get the most current forms just go to our application help page okay there's a checklist there are a number of elements that go into an application it's not just the three-page form and I'll go through each one of these and explaining we're going to go back through them and have a video clip on each one of them to give you a better feel for what is required and how to do it so you have an application with an old statement you have your transportation worker identification credentials you have a medical exam it's a very basic medical exam, but it has to be done has to be done by a nurse practitioner physician assistant or an MD cannot be done by a chiropractor for example there's some drug testing requirements you have to pay a fee of a hundred and forty-five dollars to the federal government a hundred dollars goes in for reviewing the application in forty-five dollars for the issuance of it and then the C service letters or forms, and they can get pretty complicated we'll talk about that in the next video also you need 90 days recency there's a lot of times confusion see service and one of the big things is that you must have 90 days of document it's your service on a vessel over the last three years in the last three years is from the date that your application goes in and will go back through the different routes in than Great Lakes and your Coastal's and finally you need a first aid and CPR card, so we'll talk about each one of those after we go through the application form again it's three pages there are some pages in front that our directions however there's the actual application is only three days you're going to notice that there's an expiration date of 131 2022 this is the most current form in fact these expired about two months after they were actually issued eventually I'm sure they're going to update them, but I just don't see it happening in the in the near term let's be able to see this a little.
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