Membership Application "*" indicates required fields Step 1 of 6 - General Information 16% General InformationSocial Security Number* show Social Security NumberMariner Reference Number (MRN)*0 of 8 max charactersHave you been a member of AMO previously?* Yes No I'm applying for: Deep Sea Great Lakes Inland Waters Name* First Middle Last Permanent Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is your Permanent address the same as your Mailing address?* Yes No Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth* MM slash DD slash YYYY Ethnicity* White Black Hispanic American Indian or Alaskan White Other Unknown Gender* Male Female Unspecified or another gender identity Email Address* Mobile Phone*Alternate Phone Emergency ContactName*Relationship*Phone Number*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code License / Merchant Mariner CredentialCurrent License*Limitation(s)*E.g. Tonnage, Horsepower, PropulsionMMC Expiration Date* MM slash DD slash YYYY Original License* AMO - Star Center CA - California Maritime D1 - Disctrict 1 School GLM - Great Lakes Maritime KP - Kings Point (US Merchant Marine Maritime) MA - Mass Maritime ME - Maine Maritime MMP - Masters, Mates, and Pilots NY - SUNY Maritime O/O - On Own SIU - SIU Piney Point TAM - Texas A and M School and Graduation Year*Medical Certificate Expiration DatesMedical - STCW Expiration MM slash DD slash YYYY Medical - Pilotage Expiration MM slash DD slash YYYY Medical - National Expiration MM slash DD slash YYYY Important Documents, Certificates, and CredentialsU.S. Passport Expiration* MM slash DD slash YYYY TWIC Expiration* MM slash DD slash YYYY Drug-Free Certificate* Yes No Drug-Free Certificate Expiration* MM slash DD slash YYYY Security Clearance* Yes No Deck Endorsements ARPA GMDSS Tankerman PIC (DL) Tankerman PIC (LNG) Covid-19 Vaccination StatusAre you vaccinated?* Yes No If Yes, Vaccine Brand* Pfizer Moderna Johnson & Johnson Other Date of Completed Vaccination* MM slash DD slash YYYY Employment for the Past YearCompany / EmployerEmployer PhoneEmployer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Job TitleLength of EmploymentDo you need to enter another employer? Yes No Additional EmploymentPlease enter all additional employment here. Use the above questions as a guide for what information to include.Character ReferencesFirst ReferenceName*Phone*Occupation*Second ReferenceName*Phone*Occupation* Training CertificatesMilitary Sealift CommandHelicopter Landing MM slash DD slash YYYY Helicopter Firefighting MM slash DD slash YYYY Damage Control MM slash DD slash YYYY SAAM MM slash DD slash YYYY Ship Reaction Force MM slash DD slash YYYY Security Watchstander (Basic) MM slash DD slash YYYY Security Watchstander (Advanced) MM slash DD slash YYYY EngineeringHigh Voltage MM slash DD slash YYYY Refrigerant Recovery MM slash DD slash YYYY Engineroom Resource Management MM slash DD slash YYYY Gas Turbine MM slash DD slash YYYY DeckBridge Resource Management MM slash DD slash YYYY Designated Care Provider MM slash DD slash YYYY Medical PIC MM slash DD slash YYYY ECDIS MM slash DD slash YYYY Tankerman PIC (DL) MM slash DD slash YYYY DP Training MM slash DD slash YYYY NI DP Operator MM slash DD slash YYYY Pilotage MM slash DD slash YYYY General TrainingVessel Security Training MM slash DD slash YYYY NS5 MM slash DD slash YYYY Other Training (Explain) Type(s) of Vessel(s) on Which you are ExperiencedTanker Crude Chemical Product LNG Military Sealift Command TAGOS TAGOR LMSR SL7 Dynamic Positioning Cable Surveillance Submersible Diesel Slow Speed Medium Speed Container LASH Container RO/RO Trailer Car Carrier Dry Cargo Boom Crane Other Vessel Types Heavy Lift Bulk Great Lakes Freighter Engineer (diesel) Type / HPOther Experience (Explain) Upload DocumentsAll images should be in color. All documents are securely sent directly to DropBox where they are encrypted so your data is kept safe.Please upload all pages of your Merchant Mariner Credential, including the last page with the U.S. Coast Guard signature* Drop files here or Select files Accepted file types: jpg, png, gif, pdf, Max. file size: 100 MB, Max. files: 5. Please upload the FRONT of your TWIC card* Drop files here or Select files Accepted file types: jpg, png, gif, pdf, Max. file size: 100 MB, Max. files: 5. Please upload the BACK of your TWIC card* Drop files here or Select files Accepted file types: jpg, png, gif, pdf, Max. file size: 100 MB, Max. files: 5. Please upload the full front page of your U.S. Passport* Drop files here or Select files Accepted file types: jpg, png, gif, pdf, Max. file size: 100 MB, Max. files: 5. Please upload the FRONT of your U.S. Coast Guard Medical Certificate* Drop files here or Select files Accepted file types: jpg, png, gif, pdf, Max. file size: 100 MB, Max. files: 5. Show all three expiration dates - STCW, National and PilotagePlease upload the BACK of your U.S. Coast Guard Medical Certificate* Drop files here or Select files Accepted file types: jpg, png, gif, pdf, Max. file size: 100 MB, Max. files: 5. Please upload your resume* Drop files here or Select files Accepted file types: jpg, png, gif, pdf, Max. file size: 100 MB, Max. files: 5. CAPTCHA
