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NEW MEMBER APPLICATION COVER SHEET
Name:
Flotilla: ________________
Flotilla Commander: At a minimum, ensure the “required” boxes are checked and included in this package.
Form ANSC 7001 (01-08)
□ Section I - III (pg. 1)
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o All blocks filled in (required)
Section IV (pg. 1)
o FC signature (required)
o Required attachments: (check off boxes and fill in blanks)
□ New member exam (required)
□ Fingerprints cards (2) (required)
□ Boating safety certificate
(not required for applicant status, but required for BQ status)
Section V (pg. 2)
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Boxes checked off (required)
Section VI (required if applicable)
Section VII (pg. 2)
o
Checked and signed by prospective member (required)
(If any charges (misdemeanors or felony) are on record or were on record, explain all
charges.)
Section IX (pg. 3)
o Section A (required)
o Section B (if a document was viewed the rest is required)
□ FC signature (required)
□ Copy of document viewed (required)
Section X (pg. 3)
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If a prior clearance was granted for the prospective member within the last 10 years this
section may take the place of fingerprint cards. All sections must be filled in & a source
document MUST be attached.
Page 4
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All blocks filled in (required entries in 1-6, 13 and what applies thereafter.)
(Must use N/A if not applicable) (required)
Page 5
o
All blocks filled in and signed (required)
ID Card Request (not required)
o Photo (red background, no cover, uniform, .jpg digital format)
o personal info (weight, height, eye color, hair color, blood type if known)
__________________________BELOW FOR DIRAUX USE ONLY____________________________
1) Applicant Status
a) Entered in Auxdata: F Date:___________________
Member number assigned: _____________________
b) Enter in new member database: F
c) Applicant Letter Sent: F
2) Security Authorization received:
Date:_______________
3) Update new member database: F
4) Send out new member acceptance
package. F
Last updated 25MAR2008