28
CERTIFICATE OF COMPETENCY United States of America
CERTIFICATEOF
COMPETENCY
United States of America
United States of America
Merchant Mariner Credential
This Credential has been issued under the provi-sions of the International Convention on Standards
of Training Certification on Watchkeeping for Seafarers 1978, as amended.
The lawful holder of this Credential as endorsed, is entitled under Title 46 (Shipping) U.S. Code to
serve in the capacity or capacities specified, subject to any limitations indicated.
DRAFT
MOCK
SAM
PLE
Engraved book serial number 0091034
DRAFT
MOCK
SAM
PLE
DRAFT
MOCK
SAM
PLE
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U.S. Privacy A
ct protected information required by
Title 46 (Shipping) U.S. C
ode of Federal Regulations and/or the International C
onvention on Standards of Training C
ertification on Watchkeeping for
Seafarers 1978, as amended for
This credential is not valid for service unless accompanied by a valid Transportation W
orkers’ Identification Credential
issued by the U.S. Transportation Security A
dministration.
Full Nam
e Present A
ddress
JOH
N TH
E MER
CHA
NTM
AR
INER
444 O
LD STR
EET
SEATTLE, WA
98101M
MLD
Reference N
umber
Citizenship
2500020 U
S D
ate of Issue Sex:
21-APR
IL-1998 M
ALE
Certificate Num
ber: H
air Color
NM
C0039353 B
ROW
N
Signature of Holder
Eye Color
John The Merchantm
ariner G
REEN
Date of B
irth W
eight
10-MAY-1960
160 LBS.
Place of Birth
Height
PORTLA
ND
, OR
5’ 08”
DRAFT
MOCK
SAM
PLE
Change of A
ddress 555 N
EW A
DD
RESS ST.
VIEN
NA
, VA 22180-4145
(Offi cial seal)
M. R. D
ucks
Date of change: 09-D
EC-2002
M. R. D
UC
KS, LC
DR by direction
(Offi cial seal)
M. R. D
ucks
Date of change: 09-D
EC-2002
M. R. D
UC
KS, LC
DR by direction
DRAFT
MOCK
SAM
PLE
DRAFT
MOCK
SAM
PLE
United States C
oast Guard
License to U.S. M
erchant Marine O
fficer
This is to certify that
JOH
N TH
E MERC
HA
NTM
ARIN
ER
having been duly examined and found com
petent by the undersigned, is licensed to serve as
MA
STER OF U
NITED
STATES STEA
M O
R MO
TOR V
ESSELS OF A
NY G
ROSS TO
NS U
PON
OC
EAN
S
for the tern of five years from this date:
21-APR-1998
or until the date of expiration of any extension of the validity of this certificate as may be show
n on reverse.
Office of Issue:
NA
TION
AL M
ARITIM
E CEN
TER
Com
manding O
fficerU
.S. Charliegolf
U.S. C
HA
RLIEGO
LF
This license (or certificate of registry) is not valid for service unless accompanied by a valid Transportation W
orkers’ Identification C
redential issued by the U.S. Transportation Security A
dministration.
NM
C0039353
DRAFT
MOCK
SAM
PLE
DRAFT
MOCK
SAM
PLE
U.S. M
erchant Mariner’s D
ocument
Endorsement(s) issued by the U
nited States Coast G
uard to:
JOH
N TH
E MERC
HA
NTM
ARIN
ER
1. AN
Y UN
LICEN
SED RA
TING
IN TH
E DEC
K D
EPARTM
ENT IN
CLU
DIN
G A
B
2. TAN
KERM
AN
-PIC(D
L)
3. WIPER
4. SD(FH
)
Expires:
21-APR-2003
or until the date of expiration of any extension of the validity of this certificate as may be show
n on reverse.
Issued by:
THE N
ATIO
NA
L MA
RITIME C
ENTER
Com
manding O
fficer
U.S. C
harliegolf
U.S. C
HA
RLIEGO
LF
This document is not valid for service unless accom
panied by a valid Transportation Workers’ Identification C
redential issued by the U.S. Transportation
Security Adm
inistration.
NM
C0039353
DRAFT
MOCK
SAM
PLE
DRAFT
MOCK
SAM
PLE
CERTIFIC
ATE ISSU
ED U
ND
ER THE PRO
VISIO
NS O
F THE IN
TERNA
TION
AL
CO
NV
ENTIO
N O
N STA
ND
ARD
S OF TRA
ININ
G, C
ERTIFICA
TION
AN
D W
ATC
H-
KEEPIN
G FO
R SEAFA
RERS, 1978, AS A
MEN
DED
The Governm
ent of the United States of A
merica certifies that
JOH
N TH
E MERC
HA
NTM
ARIN
ER
has been found duly qualified in accordance with the provision of regulations(s)
II/2; II/4; V/I; V
I/1; VI/2
of the above Convention, as am
ended, and has been found competent to perfom
the following functions, at the levels specified, subject
to any limitation indicated until
21-APR-2003
or until the date of expiration of any extension of the validity of this certificate as may be show
n on reverse.
This certificate is not valid for service unless accompanied by a valid Transportation W
orkers’ Identification Credential issued by the U
.S.
Transportation Security Adm
inistration.
NM
C0039353
DRAFT
MOCK
SAM
PLE
DRAFT
MOCK
SAM
PLE
Certificate N
umber: N
MC
0039353
FUN
CTIO
N*
LEVEL*
LIMITA
TION
S APPLYIN
G (IF A
NY)*
1
M
2 M
3
M
* See notes on back page of this credential
NM
C0039353
DRAFT
MOCK
SAM
PLE
DRAFT
MOCK
SAM
PLE
Certificate Number: NMC0039353
The lawful holder of this certificate may serve in the following capacity or capacities specified in the applicable safe manning requirements of the United States of America.
CAPACITY LIMITATIONS APPLYING (IF ANY)
MASTER STEAM OR MOTOR VESSELS OF ANY GROSS TONS UPON OCEANS
VALID FOR SERVICE ON VESSELS OPERATING IN THE GLOBAL MARITIME DISTRESS & SAFETY SYSTEM (GMDSS)
TANKERMAN - PIC VALID FOR SERVICE ON TANKSHIPS CARRYING DANGEROUS LIQUID OIL OR CHEMICAL CARGOES.
NMC0039353
DRAFT
MOCK
SAM
PLE
DRAFT
MOCK
SAM
PLE
FIRST CLASS PILOT OF STEAM OR MOTOR VESSELS OF ANY GROSS TON UPON THE WATERS OF SEAL ROCK TO BLIGH ISLAND, ALASKA
(Offi cial seal) S. M. Salty
Date of issue: 21-APRIL-1998 S. M. SALTY, LCDR by direction
FIRST CLASS PILOT OF STEAM OR MOTOR VESSELS OF ANY GROSS TONS UPON THE WATERS OF WHITTIER TO PASSAGE CANAL, ALASKA
(Offi cial seal) K. N. Ot
Date of issue: 11-NOV-2001 K. N. OT, CAPT by direction
FIRST CLASS PILOT OF STEAM OR MOTOR VESSELS OF ANY GROSS TONS UPON THE WATERS OF PRINCE WIL-LIAM SOUND, ALASKA
(Offi cial seal) C. M. Wangs
Date of issue: 31-JANUARY-2003 C. M. WANGS, LT, by direction
(Offi cial seal) S. M. Salty
Date of issue: 21-APRIL-1998 S. M. SALTY, LCDR by direction
(Offi cial seal) K. N. Ot
Date of issue: 11-NOV-2001 K. N. OT, CAPT by direction
(Offi cial seal) C. M. Wangs
Date of issue: 31-JANUARY-2003 C. M. WANGS, LT, by direction
DRAFT
MOCK
SAM
PLE
DRAFT
MOCK
SAM
PLE
DRAFT
MOCK
SAM
PLE
DRAFT
MOCK
SAM
PLE
This certifi cate is hereby renewed until: 03-MAR-2008
(Offi cial seal) J. A. Seadog
Date of renewal: 03-MARCH-2003 J. A. SEADOG by direction
This certifi cate is not valid for service unless accompanied by a valid Transportation Workers’
Identifi cation Credential issued by the U.S. Transportation Security Administration
NMC0039353
(Offi cial seal) J. A. Seadog
Date of renewal: 03-MARCH-2003 J. A. SEADOG by direction
DRAFT
MOCK
SAM
PLE
DRAFT
MOCK
SAM
PLE
NOTES
SELECTED DEFINITIONS AND CLARIFICATIONSAs identified in Chapter I of the Amended annex to 1978 STCW Convention, as amended
Master means the person having command of a ship;
Officer means a member of the crew, other than the master, designated as such by national law or regulations or, in the absence of such designation, by collective agreement or custom;
Deck officer means an officer qualified in accordance with the provisions of chapter II of the Convention;
Chief mate means the officer next in rank to the master and upon whom the command of the ship will fall in the event of the incapacity of the master;
Engineer officer means an officer qualified in accordance with the provisions of chapter III of the Convention;
Chief engineer officer means the senior engineer officer responsible for the mechanical propulsion and the operation and maintenance of the mechanical and electrical installation of the ship;
Second engineer officer means the engineer officer next in rank to the chief engineer officer and upon whom the responsibility for the mechanical propulsion and the operation and maintenance of the mechanical and electrical installation of the ship will fall in the event of the incapacity of the chief engineer officer;
Assistant engineer officer means a person under training to become an engineer officer and designated as such by national law or regulation;
Radio operator means a person holding an appropriate certificate issued or recognized by the Adminis-tration under the provision of the Radio Regulations;
Rating means a member of the ship’s crew other than the master or an officer;
Near coastal voyages means voyages in the vicinity of a Party as defined by that Party;
Propulsion power means the total maximum continuous rated output power in kilowatts of all the ship’s main propulsion machinery which appears on the ship’s certificate of registry or other official document;
Radio duties include, as appropriate, Watchkeeping and technical maintenance and repairs conducted in accordance with the Radio Regulations, the International Convention for the Safety of Life at Sea
and, at the discretion of each Administration, the relevant recommendations of the Organization;
DRAFT
MOCK
SAM
PLE
NOTES
REGULATIONS
As identified in Chapters II, III and IV of the Amended annex to 1978 STCW Convention, as amended
Chapter II Master and deck department
Regulation II/1 OIC of a navigational watch on ships of 500 gross tonnage (GT) or more
Regulation II/2 Masters and chief mates on ships of 500 GT or more
Regulation II/3 OIC of a navigational watch and of masters on ships of less than 500 GT
Regulation II/4 Ratings forming part of a navigational watch
Chapter III Engine Department
Regulation III/1 OIC of an Engineering Watch in a manned engine-room or designated duty engineers
in a periodically unmanned engine-room
Regulation III/2 Chief engineer officers and second engineer officer on ships powered by main propul-
sion machinery of 3,000 kW propulsion power or more
Regulation III/3 Chief engineer officers and second engineer officers on ships powered by main
propulsion machinery of between 750 kW and 3,000 kW propulsion power
Regulation III/4 Rating forming part of a watch in a manned engine-room or designated to perform
duties in a periodically unmanned engine-room
Chapter IV Radiocommunication and radio personnel
Regulation IV/2 GMDSS radio personnel
Chapter V Special training requirements for personnel on certain types of ships
Regulation V/1 Masters, officers and ratings on tankers
Regulation V/2 Masters, officers and ratings and other personnel on ro-ro passenger ships
Regulation V/3 Masters, officers and ratings and other personnel on passenger ships other than ro-ro
passenger ships
Chapter VI Emergency, occupational safety, medical care and survival functions
Regulation VI/1 Familiarization, basic safety training and instruction for all seafarers
Regulation VI/2 Certificates of proficiency in survival craft, rescue boats and fast rescue boats
Regulation VI/3 Training in advanced fire fighting
Regulation VI/4 Medical first aid and medical care
DRAFT
MOCK
SAM
PLE
NOTES
FUNCTIONS AND LEVELS OF RESPONSIBILITY
As identified in the tables of stands of competence given in Chapters II, III and IV of
Part A of the STCW Code
Functions
1. Navigation
2. Cargo handling and stowage
3. Controlling the operation of the ship and care for person on board
4. Marine engineering
5. Electrical, electronic and control engineering
6. Maintenance and repair
7. Radio communications
Levels of Responsibility
M. Management level
O. Operational level
S. Support level
DRAFT
MOCK
SAM
PLE
NOTES ON LIMITATIONS
46 U.S. Code of Federal Regulations definitions of Waters:
1. Great Lakes means the Great Lakes and their connecting and tributary waters including the
Calumet River as far as the Thomas J. O’Brien Lock and Controlling Works (between mile 326
and 327), the Chicago River as far as the east side of the Ashland Avenue Bridge (between mile
321 and 322), and the Saint Lawrence River as far east as the lower exit of Saint Lambert Lock.
2. Inland Waters means the navigable waters of the United States shoreward of the Boundary
Lines as described in 46 CFR part 7, excluding the Great Lakes and, for towing vessels, exclud-
ing the Western Rivers. For establishing credit for sea service, the waters of the Inside Passage
between Puget Sound and Cape Spencer, Alaska, are inland waters.
3. Near coastal means ocean waters not more than 200 miles offshore.
4. Oceans means the waters seaward of the Boundary Lines as described in 46 CFR part 7. For
the purposes of establishing sea service credit, the waters of the Inside Passage between Puget
Sound and Cape Spencer, Alaska, are not considered oceans.
5. Rivers means any river, canal, or other similar body of water designated by the Officer in
Charge, Marine Inspection.
6. Western Rivers means the Mississippi River, its tributaries, South Pass, and Southwest Pass,
to the navigational demarcation lines dividing the high seas from harbors, rivers, and other in-
land waters of the United States, and the Port Allen-Morgan City Alternate Route, and that part
of the Atchafalaya River above its junction with the Port Allen-Morgan City Alternate Route
including the Old River and the Red River, and those waters specified in 33 CFR 89.25.
46 U.S. Code of Federal Regulations definition of Horsepower:
Horsepower means, for the purpose of this part, the total maximum continuous shaft horse-
power of all the vessel’s main propulsion machinery.
DRAFT
MOCK
SAM
PLE
NOTESCG Form Number
1. This form replaces: a. CG-2849 (Rev. 3-04) U.S. Coast Guard License to U.S. MerchantMarineOfficer b.CG-887(Rev.6-01)U.S.CoastGuardCertificateof Registry c. CG-2838 (Rev.3-04) U.S. Merchant Mariner’s Document d. CG-5611 (Rev 01-05) U.S. STCW Endorsement
2.Theoriginalofthiscertificatemustbekeptavailableinaccordancewith Regulation I/2, paragraph 9 of the STCW Convention while serving on a ship.
3. Attention is drawn to the provision of the law whereby the fraudu-lent use and forgery or alteration of this credential could constitute a criminal offense.
4.Anypersonfindingthisdocumentshouldsenditto:
National Maritime CenterMariner Records Branch1200 Edwin Miller BoulevardMartinsburg, WV 25404United States of America
Postage will be paid by the addressee.
5.Thevalidityofthiscertificatecanbecheckduringofficehoursbycontacting the National Maritime Center at the address shown above orbythee-mail:[email protected]“CertificateVerification”templateontheInternationalMaritimeOrganization’s website www.imo.org
6.ThiscertificateisnotvalidforserviceunlessaccompaniedbyavalidTransportationWorkers’IdentificationCredentialissuedbytheU.S. Transportation Security Administration.
