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The CG-719S form, known as the Small Vessel Sea Service Form, is an essential document for individuals seeking to obtain a U.S. Merchant Mariner Credential (MMC) for vessels under 200 gross register tons. This optional form allows applicants to present their sea service experience in a structured manner. It collects vital information, including applicant details, vessel particulars, and a thorough record of the days served on the vessel. Each applicant must complete a separate form for each vessel, and can provide information across multiple years, evidencing their experience at sea. Sections within the form guide users through documenting their roles, such as Master, Mate, or Deckhand, while also noting the bodies of water where they operated. The form concludes with an affirmation of the information provided, which can be certified by vessel owners or licensed personnel to substantiate claims of service. Notably, it serves not only to confirm experience but also to adhere to regulatory standards outlined by the Coast Guard. Understanding this form is crucial for anyone pursuing a maritime career, as it encapsulates both personal and professional journeys across waters.

Cg 719S Example

 

 

 

 

 

 

 

 

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

 

 

 

Reference Number (if applicable)

 

Social Security Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vessel Name

 

 

 

 

 

 

 

 

 

 

 

 

Official number(s) listed on the registration, certificate, or document

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Length

 

 

 

 

 

 

Width (if known)

 

Depth (if known)

 

 

Vessel Gross Tons

 

 

 

Feet

 

 

Inches

Feet

 

 

Inches

 

Feet

 

 

 

 

Inches

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Propulsion (Motor/Steam/Gas Turbine/Sail/Aux Sail)

 

 

 

 

 

 

 

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

 

 

 

 

 

February

 

 

 

March

 

 

 

 

 

April

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Year

 

Days

 

 

 

Year

 

 

 

 

Days

 

Year

 

 

 

 

Days

Year

 

Days

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

May

 

June

July

 

 

August

 

 

 

 

 

 

 

 

 

 

 

 

Year

 

Days

Year

 

Days

Year

 

Days

Year

 

Days

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

September

 

October

 

November

 

 

December

 

 

 

 

 

 

 

 

 

 

 

 

Year

 

Days

Year

 

Days

Year

 

Days

Year

 

Days

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total number of days served on this vessel:

Average hours underway (per day)?

Average distance offshore:

Number of days served on Great Lakes:

Number of days served on waters shoreward of the boundary line as defined in 46 CFR Part 7:

Number of days served on waters seaward of the boundary line as defined in 46 CFR Part 7:

CG-719S (04/17)

Page 1 of 2

SMALL VESSEL SEA SERVICE FORM (OPTIONAL CG-719S)

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).

Signature of Applicant

Date (MM/DD/YYYY)

 

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. 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).

Signature and Title of Person Attesting to Experience

Date (MM/DD/YYYY)

 

x

Owner's, Operator's, or Master's Name

Last

First

Middle

 

 

 

 

 

 

 

 

 

 

 

 

Email Address (Optional)

Owner's, Operator's, or Master's address and phone number

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. In addition, the Coast Guard uses this information to maintain and update records of merchant mariner documentation transactions. The information will not be shared outside of DHS except in accordance with the provisions of DHS/USCG-030 Merchant Seamen's Records System of Records, 74 FR 30308 (June 25, 2009).

Disclosure: Furnishing this information (including your SSN) is voluntary; however, failure to furnish the requested information may result in the non-issuance of the MMC, any endorsement within the MMC, and medical certificate.

An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The United States Coast Guard estimates that the average burden for this report is 15 minutes. You may submit any comments concerning the accuracy of this burden estimate or any suggestions for reducing the burden to: Chief, Office of Merchant Mariner Credentialing, 2703 Martin Luther King, Jr. Ave, S.E., STOP 7509, Washington, D.C., 20593-7509 or Office of Management and Budget, Paperwork Reduction Project (1625-0040), Washington, DC 20503.

CG-719S (04/17)

Page 2 of 2

Form Characteristics

Fact Name Details
Form Purpose The CG-719S is used to document sea service on vessels under 200 gross register tons.
Governing Agency This form is regulated by the U.S. Coast Guard.
Expiration Date The form is set to expire on March 31, 2021, based on OMB regulations.
Mandatory Fields Applicants must provide details like their name, social security number, and vessel information.
Service Verification Vessel owners or licensed personnel must verify the applicant's reported service.
Legal Consequences False statements made on the form can result in fines or up to five years of imprisonment.
Average Daily Service Applicants must report their average hours underway per day.
Geographic Reporting Service on different bodies of water can be documented, including the Great Lakes.
Privacy Notice Information collected is used strictly for assessing qualifications for a U.S. Merchant Mariner Credential.
Voluntary Disclosure Furnishing information, including Social Security Number, is voluntary but impacts credential issuance.

Guidelines on Utilizing Cg 719S

Completing the Cg 719S form is straightforward. This form gathers important information about your service on vessels less than 200 gross register tons. Follow these instructions carefully to ensure your application is processed smoothly.

  1. Section I: Applicant Information
    Fill in your name, including last, first, and middle. Provide a reference number if applicable. Enter your Social Security number, the vessel's name, and its official number (if available). Make sure to include the vessel's dimensions: length, width, and depth in feet and inches. Specify the vessel's gross tons and propulsion type (e.g., Motor, Sail). State your position onboard, such as Master or Deckhand, and list the bodies of water the vessel navigated.
  2. Section II: Record of Underway Service
    Under each month, note the number of days you served on the vessel for each corresponding year. If your service spans multiple years, document each separately. Go ahead and total the days served on that vessel at the bottom. You’ll also need to answer questions about average hours underway per day, average distance offshore, and the number of days served in specific zones like the Great Lakes or waters defined in 46 CFR Part 7.
  3. Section III: Signature and Verification
    Read the statements carefully. Sign as the applicant to certify your experience serving on the vessel. Include the date in MM/DD/YYYY format. If applicable, the vessel owner, operator, or master must also sign the form, along with their name, email address (optional), and contact information.

Once you’ve completed the form, review it for accuracy. Signatures and dates are essential for processing your application. After that, submit the form according to the provided instructions for your next steps.

What You Should Know About This Form

What is the purpose of the CG-719S form?

The CG-719S form, also known as the Small Vessel Sea Service Form, is utilized by the U.S. Coast Guard to collect information from individuals seeking to obtain a U.S. Merchant Mariner Credential (MMC). This form specifically records the sea service of individuals who have served on vessels of less than 200 gross register tons. The information you provide helps assess whether you meet the regulatory standards required to operate a vessel. Accurate and complete information is essential in determining your qualifications.

Who needs to fill out the CG-719S form?

Individuals who are applying for a credential to operate a small vessel under the U.S. Coast Guard's jurisdiction must complete the CG-719S form. This applies to both vessel owners who can attest to their own experience and those who have served on someone else's vessel. If you do not own the vessel, you will need to gather letters or other documentation from licensed personnel or the vessel's owner attesting to your service.

How is the information on the CG-719S form used?

The information collected on the CG-719S form is primarily used to verify an applicant's experience at sea. The U.S. Coast Guard reviews this data to ensure compliance with national and international maritime regulations. It plays a critical role in maintaining the safety standards of those operating vessels. The information may also be utilized to update records of merchant mariner documentation transactions, contributing to the overall integrity of maritime operations.

What happens if I provide false information on the CG-719S form?

Providing false or fraudulent statements on the CG-719S form can have serious legal repercussions. Individuals who knowingly submit inaccurate information may face penalties, including fines or imprisonment of up to five years, under 18 U.S.C. 1001. The Coast Guard takes such violations very seriously, and the integrity of the application process is enforced to ensure the safety of all maritime operations.

Common mistakes

When filling out the Cg 719S form, one common mistake individuals make is providing incorrect or incomplete personal information. Providing details such as the applicant's name, social security number, or vessel name needs to be accurate. An error in this section can lead to delays in processing or even a rejection of the application.

Another mistake is failing to accurately record the days of service under the appropriate months. Each applicant must record the number of days served for every individual year. If any of this information is missing or inaccurately reported, it can result in a discrepancy in the service record, which may affect eligibility for credentials.

Additionally, some individuals overlook the requirement to clarify their role on the vessel. Properly indicating whether the applicant served as a master, mate, or another position is essential. Missing this information could lead to misunderstandings regarding experience levels and qualifications.

Lastly, many applicants neglect to read the signature and verification sections thoroughly. The certifications regarding the truthfulness of the statements must be acknowledged, and this includes understanding the consequences of providing false information. Not recognizing the seriousness of this part can impact an applicant's future credentials.

Documents used along the form

The CG-719S form is commonly used to document sea service experience for individuals operating small vessels. When submitting this form, other documents may also be required or beneficial for your application. Below are some of these important forms and documents.

  • CG-719B: This is the Application for Merchant Marine Credential. It is a comprehensive form that applicants must complete to request various maritime credentials.
  • CG-719K: This form is a Medical Evaluation report. It serves to document an applicant’s medical fitness, which is necessary for obtaining a Merchant Mariner Credential.
  • Service Letters: These letters provide official verification of an individual's maritime service. They can come from vessel owners or operators and must detail the nature of the experience.
  • Proof of Ownership: This document can establish the applicant’s ownership of the vessel listed on the CG-719S form. It can include title documents, registration, or bill of sale.
  • Sea Service Verification: This document outlines the specifics of the service time spent on vessels. It could detail hours, dates, and activities performed while aboard.
  • Form CG-5377: This is the Report of Sea Service, which records additional sea service that may not be included in the CG-719S form. It helps in providing a comprehensive sea service record.
  • Certificate of Completion: For individuals who have completed a Coast Guard-approved training course, this certificate can document that training and enhance credibility.
  • Photo Identification: A government-issued ID, such as a driver's license or passport, may be required to verify identity when submitting forms.
  • Application Fee: Proof of payment for any applicable fees related to the Merchant Mariner Credential application should also be included.

By gathering and submitting these documents along with the CG-719S form, applicants can ensure a smoother application process for their Merchant Mariner Credential. Each item plays a vital role in demonstrating qualifications and compliance with US Coast Guard requirements.

Similar forms

  • CG-719B Form: This is used to document service for larger vessels. It tracks similar information like the vessel's name and the applicant's service records, but accommodates larger gross tonnage.

  • CG-719K Form: This form is for documenting medical evaluations for mariners. While it focuses on health, it still works alongside the CG-719S to determine qualifications for operating a vessel.

  • CG-719P Form: This form is a personal and financial disclosure. Like the CG-719S, it is required for mariner credentialing and includes information about the applicant’s background.

  • CG-7004 Form: Used for mariner credential applications, this form captures basic information, including personal history, similar to the initial sections of the CG-719S.

  • CG-6038 Form: This form records service on fishing vessels. While it targets a specific industry, it serves the same purpose of documenting service hours and experiences.

  • Merchant Mariner Credential (MMC): The MMC itself integrates information from various forms, including the CG-719S, to establish a mariner's eligibility to operate vessels.

  • STCW Certificates: These documents certify training and competencies of mariners. While focused on skills and training, they complement the service records kept in the CG-719S.

Dos and Don'ts

The Cg 719S form is crucial for those looking to document their sea service on vessels under 200 gross register tons. Filling it out correctly is essential for avoiding delays or issues with your application. Here are ten tips to help you navigate the process.

  • Do read the instructions carefully before starting to fill out the form.
  • Do complete one form for each vessel you have served on.
  • Do provide accurate information regarding your service to avoid any legal issues.
  • Do ensure your contact information is current and complete.
  • Do gather supporting documentation to verify your service, such as letters from vessel owners.
  • Don't submit incomplete forms; all sections must be filled out as required.
  • Don't falsify any information; this can lead to severe penalties including fines and imprisonment.
  • Don't forget to sign and date the form; both the applicant and the attester must provide their signatures.
  • Don't miss the deadline for submission, as late submissions can affect your credentialing process.
  • Don't overlook the privacy notice; understand how your information will be used and protected.

Misconceptions

There are several misconceptions about the CG 719S form, often leading to confusion among potential applicants. Understanding these can help ensure a smoother application process. Here are five common misconceptions:

  • Misconception 1: The CG 719S form is mandatory for all applicants.
  • In reality, the CG 719S form is optional. It is specifically used to document sea service for individuals applying for a credential to operate a vessel of less than 200 gross register tons. While it may be helpful for documenting experience, not all applicants are required to fill it out.

  • Misconception 2: You can only use the CG 719S form for one vessel.
  • This is not true. You can complete one form per vessel, but you can also submit multiple forms for different vessels if needed. Each form should reflect your sea service on that specific vessel to maintain clarity.

  • Misconception 3: Only vessel owners can attest to service on the CG 719S form.
  • This misconception overlooks the details of the form. While vessel owners may certify their own experience, licensed personnel or other vessel owners can also provide letters or evidence of sea service. This flexibility helps accommodate various situations.

  • Misconception 4: Filling out the CG 719S form guarantees a credential.
  • Submitting the CG 719S form does not automatically mean that you will receive a Merchant Mariner Credential (MMC). The Coast Guard evaluates all applications based on various regulatory standards, and meeting those is essential for credential approval.

  • Misconception 5: Information provided on the form is shared widely.
  • In fact, the information collected on the CG 719S form is protected and not shared outside the Department of Homeland Security unless required by regulations. The purpose of collecting information is solely for evaluating qualifications for a credential.

Addressing these misconceptions can help clear up confusion and streamline the process for those applying for maritime credentials. Always consult the latest guidelines and regulations to ensure compliance.

Key takeaways

Here are key takeaways about filling out and using the CG-719S form:

  • Complete one form for each vessel you served on, providing your name and relevant details.
  • Include your Social Security Number for identification purposes.
  • Record the vessel's name, official number, and physical dimensions accurately.
  • Indicate the type of propulsion the vessel uses—motor, steam, gas turbine, sail, or auxiliary sail.
  • Clearly state your role on the vessel such as master, mate, operator, or deckhand.
  • Document the number of days served under each month for the required year.
  • Calculate and record the total number of days served on the vessel.
  • Provide the average hours underway per day and details on distances offshore.
  • If you do not own the vessel, acquire letters from licensed personnel or the owners attesting to your experience.
  • Be aware that falsifying information may lead to serious penalties, including fines or imprisonment.