Character References as Required by U.S. Coast Guard

I, the undersigned, Certify from personal knowledge that the above named applicant is a person of temperate habits and of
good character and recommend him/her as a suitable person to be entrusted with the duties of the Station for which
application is made.
Name:
First Reference:
Address:
Phone:
Signature:
E-mail:
Recommendation:
APPLICANT'S NAME:
Per CFR 11.205 (c) Character check and references. (1) Each applicant for an original officer or STCW endorsement must
submit written recommendations concerning the applicant's suitability for duty from a master and two other individuals
holding officer endorsements or licenses on vessels on which the applicant has served.
I, the undersigned, Certify from personal knowledge that the above named applicant is a person of temperate habits and of
good character and recommend him/her as a suitable person to be entrusted with the duties of the Station for which
application is made.
Name:
Second Reference:
Address:
Phone:
Signature:
E-mail:
Recommendation:
I, the undersigned, Certify from personal knowledge that the above named applicant is a person of temperate habits and of
good character and recommend him/her as a suitable person to be entrusted with the duties of the Station for which
application is made.
Name:
Third Reference:
Address:
Phone:
Signature:
E-mail:
Recommendation:
SAMPLE - CHARACTER REFERENCES AS REQUIRED BY U.S. COAST GUARD
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