Cg 719c 2026

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The document is a Disclosure Statement for Narcotics, DWI/DUI, and/or Other Convictions (Optional Form CG-719C) issued by the U.S. Coast Guard. It outlines the requirements for original Merchant Mariner Credential (MMC) applicants to disclose all relevant convictions, including military and driving-related offenses. The form includes sections for applicant information, conviction details, and an acknowledgment of the accuracy of the provided information. It emphasizes the importance of full disclosure to avoid delays or denial of credentials and provides guidance on what constitutes a conviction.

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Click ‘Get Form’ to open the CG-719C in the editor.
In Section I, enter your Legal Name, including any aliases or maiden names. If you have a previous reference number from the Coast Guard, include it here along with your Social Security Number and Date of Birth.
Move to Section II for Conviction and/or Drug Use Disclosure. List each conviction by entering the exact charge, city, state/country, date of conviction, court findings, and any court sentence requirements. Provide a brief description of events leading to your arrest.
In Section III, sign and date the form to acknowledge that you understand the definition of 'conviction' and certify that all information provided is accurate.

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