Entry-Level Merchant Mariners Document (MMD)

CHECKLIST
APPLICATION (CG-719B):
Section I: Verify that every block is filled out, or write N/A.
Section I: Ensure your mailing address is correct.
Section I: Next of kin name, address and relationship are required by law.
Section II: Write Entry-level MMD in the applying for box.
Section III: Read the definition of conviction and answer the questions honestly.
Section III: Write a statement for all yes answers (when, where and what).
Section III: Provide court documentation for recent convictions (i.e. within 5 years).
Section III: Sign and date section III, attesting that your answers are truthful.
Section V: Sign and date section V, the NDR consent.
Section VI: Sign and date section VI, 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, and some Regional Examination Centers (REC) accept cash.
When paying by check or money order, include your name, address, and SSN on it.

CITIZENSHIP AND NATIONALITY:

For U.S. Citizens, original proof of citizenship is required, use the acceptable list.
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:
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.
Original social security card is required for all applicants.
FINGERPRINTS:
Fingerprints are required, and they must be taken by REC personnel.
PASSPORT PHOTOS:
Two passport photos are required.
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):
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 section IV, certifying the information is true.
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:
Revised: 09/12/2007

Bring your completed application and associated documentation to a REC in-person.

Include this completed checklist with your application package.

Revised: 09/12/2007