Disclosure Statement for Narcotics DWI DUI Convictions
This document is a disclosure statement for individuals applying for a Merchant Mariner Credential. It outlines the requirements for reporting criminal convictions related to narcotics, DWI, and DUI. Proper completion is essential to ensure timely processing of your credential application.
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How do I fill this out?
Filling out this form is crucial for your application. Begin by gathering all your conviction details, including dates and locations. Follow the structured sections to provide accurate information and ensure that all required fields are completed.

How to fill out the Disclosure Statement for Narcotics DWI DUI Convictions?
1
Gather your complete legal name and any aliases.
2
Collect details of any convictions, including dates and locations.
3
Fill out the form section by section, ensuring accuracy.
4
Sign and date the form to certify the information is true.
5
Submit the completed form as per the submission guidelines.
Who needs the Disclosure Statement for Narcotics DWI DUI Convictions?
1
Merchant mariner credential applicants must report all convictions.
2
Individuals with previous Coast Guard documentation who are renewing their credentials.
3
Those applying for endorsements on their existing credentials.
4
Military personnel seeking to transition to civilian merchant marine roles.
5
Anyone with criminal convictions who needs to assess their eligibility for marine service.
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1
Open the PDF in the PrintFriendly editor.
2
Click on the field you wish to edit and make your changes.
3
Add or remove details as necessary.
4
Review your changes to ensure accuracy.
5
Download the edited PDF for submission.

What are the instructions for submitting this form?
To submit this form, ensure that all sections are fully completed. You can either fax the completed form to the designated office or submit it through an online portal if available. Physical submissions can be mailed to the Coast Guard's Office of Merchant Mariner Credentialing at 2703 Martin Luther King, Jr., Ave, S.E., STOP 7509, Washington, D.C., 20593-7509. Always check for the latest submission guidelines and preferred methods.
What are the important dates for this form in 2024 and 2025?
As of now, there are no specific upcoming dates related to this form in 2024 or 2025. However, ensure to comply with any updates issued by the Coast Guard by regularly checking their official site. Keep an eye out for any changes in submission requirements or procedures.

What is the purpose of this form?
This form serves as a crucial component of the application process for a Merchant Mariner Credential. It is designed to gather necessary information regarding any criminal convictions related to narcotics, DWI, or DUI. The purpose is to ensure that applicants meet the regulatory standards set forth by the Coast Guard for safety and suitability in marine occupations.

Tell me about this form and its components and fields line-by-line.

- 1. Legal Name: Complete legal name along with any aliases.
- 2. Reference Number: Previous Coast Guard credential reference number, if applicable.
- 3. Social Security Number: Your SSN is required for new applications.
- 4. Date of Birth: Birth date for identity verification.
- 5. Conviction Details: Specifics about convictions including dates, locations, and court findings.
What happens if I fail to submit this form?
Failure to submit this form can result in significant delays in processing your credential application. It could also lead to denial of your application if critical information is missing. Therefore, it is imperative to complete and submit the form accurately and on time.
- Application Delays: Incomplete submissions can lead to extended processing times.
- Risk of Denial: Failing to disclose convictions can result in outright denial of your credential.
- Inaccurate Information: Providing false information can lead to legal repercussions and jeopardize your application.
How do I know when to use this form?

- 1. Initial Application: Needed for first-time applicants for a Merchant Mariner Credential.
- 2. Renewals: Required to update any criminal conviction information during the renewal process.
- 3. Endorsements: Necessary when applying for additional endorsements.
- 4. Employment Assessments: Utilized for employment in marine occupations.
- 5. Compliance Evaluation: Used by Coast Guard personnel for compliance with safety regulations.
Frequently Asked Questions
What is the purpose of this form?
The form collects information about criminal convictions to assess eligibility for a Merchant Mariner Credential.
How do I download the edited PDF?
You can download the edited PDF directly after making changes in the editor.
Can I submit this form online?
Yes, you can fill out and submit the form electronically via our platform.
What if I have multiple convictions?
You must list all convictions, including minor ones, on the form.
How do I know if I qualify for a credential?
The Coast Guard will evaluate your convictions and suitability based on the information you provide.
Is there a deadline for submitting this form?
You should submit your form as early as possible to avoid delays in processing your credential.
What happens if I don't disclose my convictions?
Failure to disclose can lead to application delays or denial.
Can I edit the form after I've filled it out?
Yes, you can return to the document to make edits at any time before submitting.
Do I need to sign the form?
Yes, your signature is required to certify the accuracy of the information.
What if I have further questions about filling out the form?
You can refer to our detailed guidelines or contact our support for assistance.
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