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0%
 
Check only one.
What licensing transaction did you apply for?
 
Original Issue
 
Renewal
 
Upgrade
 
Endorsement
 
Replacement
 
 
Check as many as required.
What type of Coast Guard Credential did you apply for?
 
License
 
MMD
 
STCW Certificate

 
 
Check the answer that is most appropriate.
How long did it take to complete your transaction with the Coast Guard?
 
Under 3 months
 
Over 3 months but under 6 months
 
Over 6 months but under 9 months
 
Over 9 months but under 1 year
 
Over 1 year
 
 
Check the answer that applies.
If you were renewing a credential, was the time it took to renew longer now, than before September 11, 2001?
 
Yes
 
No
 
N/A
 
 

Were you informed that your application had any problems (security or otherwise)?
 
Yes
 
No
 
 

Did you honestly disclose your history on the application?
 
Yes
 
No
 
 
Check all that apply.
Did you check yes to any of the following questions on your application?
 
Have you ever been convicted of violating a dangerous drug law of the United States, District of Columbia, or any state, or territory of the United States?
 
Have you ever been a user of/or addicted to a dangerous drug, including marijuana?
 
Have you ever been convicted by any court - including military court - for an offense other than a minor traffic violation?
 
Have you ever been convicted of a traffic violation arising in connection with a fatal traffic accident, reckless driving or racing on the highway or operating a motor vehicle while under the influence of, or impaired by, alcohol or a controlled substance?
 
Have you ever had your driver's license revoked or suspended for refusing to submit to an alcohol or drug test?
 
Have you ever been given a Coast Guard Letter of Warning or been assessed a civil penalty for violation of maritime or environmental regulations?
 
Have you ever had any Coast Guard license or document held by you revoked, suspended or voluntarily surrendered?
 
None of these

 
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