Welcome to the National Maritime Center's instructional video on completing the U.S. Coast Guard 719 series of application forms. CG 719KE is the application for a merchant mariner medical certificate for entry-level ratings. The first two pages provide detailed instructions on filling out the CG 719KE form. Each section listed in the instruction corresponds with a specific section of the form. The table on page 2 provides details of the requirements for a demonstration of physical ability. Also, throughout the form, there are instructions following each section heading which indicate whether the applicant or the medical practitioner should complete each section. Please read these instructions carefully prior to filling out the application. In section 1, please fill in each block with appropriate contact information or write "n/a" if not applicable. For section 2, applicant certification, please read carefully, sign, and date the Privacy Act statement mentioned. It can be found on page 4 of this form. Sections 3, 4, and 5 address physical information, demonstration of physical ability, and food handler certification. These sections are to be completed by the medical practitioner. Please ensure that all sections are addressed and filled in completely by your medical practitioner prior to submitting this form to the National Maritime Center. Detailed guidance on the medical and physical evaluation guidelines for merchant mariner credentials can be found in Navigate, located on our website. This section is reserved for the medical practitioner's information. Please be sure that the practitioner's signature, contact information, and license information are included in this section. Please read the Privacy Act statement to better understand how your private information will be used. There are several ways to contact us if you're having problems with emailing your application. Visit the National Maritime Center website at wwlp.com. You can also reach our customer service center and...
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National maritime center Form: What You Should Know
NMC forms for Merchant Marine Certificate, Merchant Mariner Credential and Marine Engineer Certificate and/or Airman Medical Certificate (MMC) are listed here. MMC forms for Merchant Marine Certificate, Merchant Mariner Credential and Marine Engineer Certificate and/or Airman Medical Certificate (MMC) are listed here. Merchant Marine Credential forms for Merchant Marine Certificate and Commercial Fisherman's Card are available on page 9 and Merchant Marine Credential forms for the Commercial Fisherman Card are available on page 14. National Maritime Center (NMC) Home Page — Coast Guard NMC Forms — Merchant Marine Certificate (CG-740) NMC Forms — Merchant Mariner Credential (CG-904). NMC Forms — Merchant Mariner medical certificate (CG-913). NMC Forms — Merchant Mariner Medical Certificate Application for Medical Certificate (CG-719B). Mariners Seeking a Coast Guard Approved Medical Credential for a Ship of Merchant Marine Registry Information that will be required from you when submitting these forms to the National Maritime Center: Complete one CFI Application Package (SF 15). Do not submit any additional Form SG-2 forms. Complete one CFP Application Package. Do not submit any additional forms for the CFP. Provide the CFP with the SF 14 CFI forms. Be aware that they must complete and provide to NMC the SF 14 CFI forms and the SF 14 CFP forms. Provide and complete one Merchant Mariner Medical Certificate Application for Medical Certificate (SF 14C) to NMC. Complete one Merchant Mariner Medical Certificate Application for Medical Certificate (PF 30, PF 31). The Merchant Mariner Medical Certificate Application for Medical Certificate (SF 14C) is available to you by the following documents: (1) Physical Form SF 14C — PDF form (2) Medical Records — PDF files (3) Physical Form SF 14C — PDF form. This form must be completed by a qualified physician. The physical form will be located outside the container in which it is submitted. If you are submitting multiple forms (e.g. a medical certificate, SF 14C, CFP and medical records), then you must complete one form prior to submitting the next form.
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