Form CG-719C: Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions

When and How to Submit Form CG-719C

Click below to download the conviction form 👇 

Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions (Optional) (CG-719C)

What is the CG-719C form?

Every application that requires a safety and suitability evaluation is completed by the Safety and Suitability Evaluation Branch. Form CG-719C discloses convictions from the applicant's history. Be truthful on these forms, and do not attempt to hide anything, as the Coast Guard will find out. 

📽️ Here is a quick video on court convictions. 

What does the National Maritime Center consider a conviction? 

The National Maritime Center (NMC) considers a conviction to include various legal outcomes in any jurisdiction. Specifically, if an applicant pleads guilty or no contest to, or is given any of the following, they are considered to have received a conviction:

• Guilty/No Contest
• Deferred Adjudication
• Required Class Attendance
• Contributions of Time/Money
• Receive Treatment
• Probation/Supervision
• Forgo Appeal of Court’s Conviction

It's important to note that expungement of a conviction will not negate the conviction unless the expungement shows that the court's earlier conviction was in error. In such cases, the applicant would need to provide documentation showing the expungement was based on an error by the court.

The NMC evaluates these factors as part of their process to determine an applicant's fitness for duty and their eligibility for a Merchant Mariner Credential (MMC).

How do I complete this form?

To complete the form, use an Adobe PDF application. Alternatively, you can print the form, manually fill it out, scan it back into a PDF format, and save the file with the appropriate name. 

Once completed, save the document to your desktop using the following file name format: LAST NAME_FIRST NAME_MARINER REFERENCE NUMBER (Note: Original applicants will not have a Mariner Reference Number yet). 

Do I need to submit this form if I have no history of convictions?  

If you have no history of convictions, you will NOT need to submit form CG-719C to the Coast Guard. 

📑 Read over this article for more information.