Entry-Level Merchant Mariner’s Document (MMD)
CHECKLIST
APPLICATION (CG-719B):
o / Section I: Verify that every block is filled out, or write “N/A”.
o / Section I: Ensure your mailing address is correct.
o / Section I: Next of kin name, address and relationship are required by law.
o / Section II: Write “Entry-level MMD” in the applying for box.
o / Section III: Read the definition of conviction and answer the questions honestly.
o / Section III: Write a statement for all “yes” answers (when, where and what).
o / Section III: Provide court documentation for recent convictions (i.e. within 5 years).
o / Section III: Sign and date section III, attesting that your answers are truthful.
o / Section V: Sign and date section V, the NDR consent.
o / Section VI: Sign and date section VI, certifying the application is true and correct.
FEES:
o / Include $140.00 with your application. You can pay by check; money order, credit/debit card, pay.gov, and some Regional Examination Centers (REC) accept cash.
o / When paying by check or money order, include your name, address, and SSN on it.
CITIZENSHIP AND NATIONALITY:
o / For U.S. Citizens, original proof of citizenship is required, use the acceptable list.
o / For Aliens, original proof of nationality is required, use the acceptable list. 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.
IDENTITY:
o / Two current forms of identification are required, one of which shall contain a photo of the applicant. Proof of citizenship or nationality may be used for identification purposes.
o / Original social security card is required for all applicants.
FINGERPRINTS:
o / Fingerprints are required, and they must be taken by REC personnel.
PASSPORT PHOTOS:
o / Two passport photos are required.
o / Sign the Mariner Identification System Scanner Image Capture Form, Version 2, FM-REC-102(01) and include it with your package.
CERTIFICATION OF FITNESS (CG-719K/E):
o / Verify that every block is filled out properly.
o / Section III: Ensure all the physician contact information is filled out, and ensure that your physician signed and dated the form.
o / Section IV: Sign and date section IV, certifying the information is true.
DRUG TEST:
o / Periodic: MRO signed the document.
o / Periodic: Document is original; photocopies are unacceptable.
o / Random & Pre-employment: Original company letter meets requirements.
DELIVERY OF APPLICATION PACKAGE:
o / Bring your completed application and associated documentation to a REC in-person.
o / Include this completed checklist with your application package.
Revised: 09/12/2007