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SouthEast Alaska Pilots’ Association

1621 Tongass Avenue, Suite 300  Ketchikan, Alaska 99901  907-225-9696  fax 907-247-9696  pilots@seapa.com

APPLICATION FOR SOUTHEAST ALASKA PILOT’S


ASSOCIATION -TRAINEE SELECTION

PERSONAL INFORMATION Name:

(First) (Middle) (Last)


____________________________________________ Date: ___________

Social Security Number: _________/__________/__________ DOB: ___________

U.S. Citizen: Yes _____ No _____ Alaska State Resident: Yes _____ No _____ Present

Address and Contact Information:

Primary Contact Telephone Nr (mandatory) ________________________________

E-Mail Address (mandatory): ___________________________________________

Alternate Contact Information:___________________________________________

EDUCATION High School Graduate: Yes _____ No _____ (Must

be a High School Graduate) College: _____________________________ Last Year

Completed: 1 2 3 4 College Degree Major:

________________________________________________

PROFESSIONAL SCHOOLS AND TRAINING (Use additional sheets if necessary)

(School) (Course / Training) (Date)


_________________________/_______________________/__________________

(School) (Course / Training) (Date)


_________________________/_______________________/__________________
_________________________/_______________________/__________________
(School) (Course / Training) (Date)
SOUTHEAST ALASKA PILOT’S ASSOCIATION – TRAINEE APPLICATION PAGE 2 OF 5

UNITED STATES COAST GUARD LICENSE INFORMATION USCG License

(Provide copy of front and back of license)


Information: ____________________________________________

USCG License Number: _____________________ Issue Number: _____________

Pilotage Endorsements: _______________________________________________

Have you ever had an action taken against your U.S. Coast Guard License? Yes _____ /

No _____ If yes, please explain: ______________________________

EMPLOYMENT HISTORY (Attach


additional sheets as necessary)

__________________________________/_________________________________
(Company) (Position)

_________________/__________________________________________________
(Length of Employment) (Contact Person & Telephone Nr)

__________________________________/_________________________________
(Company) (Position)

_________________/__________________________________________________
(Length of Employment) (Contact Person & Telephone Nr)

__________________________________/_________________________________
(Company) (Position)

_________________/__________________________________________________
(Length of Employment) (Contact Person & Telephone Nr)

__________________________________/_________________________________
(Company) (Position)

_________________/__________________________________________________
(Length of Employment) (Contact Person & Telephone Nr)
WORK EXPERIENCE (Attach additional sheets as necessary) PILOTING

EXPERIENCE: On vessels NLT (not less than) 1600 GT Yes ____ / No ____ Number

of Years AND Movements: ________/_________ DEEP DRAFT EXPERIENCE:

Qualifying service only on self-propelled vessels NLT


1600 GT or 3000 ITC or U.S. commissioned vessels NLT 200 feet length over all. Yes

____ / No ____ Number of Years and Months: ________/________ Master / Command

Deep Draft Experience Yes ____ / No ____ Number of Years and Months:

________/________ Chief Mate / Staff Captain / Executive Officer Deep Draft

Experience Yes ____ / No ____ Number of Years and Months: ________/________

Master / Command Deep Draft Experience on self-propelled vessels NLT 10,000 GT

Yes ____ / No ____ Number of Years and Months: ________/________ TUG AND

TOWING VESSEL EXPERIENCE: Master Experience on tugs conducting ship assist

work Yes ____ / No ____ Number of Years and Months: ________/________ Master

Experience on tugs with tows combined tonnage NLT 1600 GT Yes ____ / No ____

Number of Years and Months: ________/________ Chief Mate Experience on tugs with

tows combined tonnage NLT 1600 GT Yes ____ / No ____ Number of Years and

Months: ________/________ ALASKA EXPERIENCE: Master Experience in Alaska?

Yes ____ / No ____ Number of Years and Months: ________/________ RECENCY: Is

any of the above experience within the previous seven (07) years? Yes ____ / No ____

Number of Years and Months: ________/________

If yes to any of the above, provide documentation to support experience that


clearly documents the amount of time claimed.
OTHER INFORMATION

If a “yes” answer is given to a question, provide a complete explanation on a


separate page. Have you ever been convicted of a felony?

Yes _____ / No _____ Date(s) ____________________________ Have you ever


been convicted of any repeat misdemeanor offenses involving the illegal use of
alcohol?

Yes _____ / No _____ Date(s) ____________________________ Have you ever had a

conviction involving the possession, use, or sale of drugs? Yes _____ / No _____

Date(s) ____________________________ Have you ever had a marine or motor

vehicle driver’s license revoked or suspended


or limited in any jurisdiction? Yes _____ / No _____ Date(s)

____________________________

CHECK LIST ________ Attach copy (front and back) of valid

U.S. Coast Guard license ________ Attach three (03) letters of reference from

previous employers ________ Attach three (03) letters of reference from previous

vessel Masters you


Have worked with ________ Attach copies of documented sea-service time

and experience ________ Attach copy of current drug test (within 6 months) or letter

of enrollment
In random drug testing program ________ Attach documentation of

explanation to any “yes” answers above ________ Attach a check for $50.00

(nonredundable) made payable to Sea Pilots, Inc.


SOUTHEAST ALASKA PILOT’S ASSOCIATION – TRAINEE APPLICATION PAGE 5 OF 5

APPLICANT’S AGREEMENT AND CERTIFICATION

I certify that the information given by me on this application is true in all respects, and I
agree that if the information given is found to be false in any way, it shall be considered
sufficient cause for disqualification as an applicant. I authorize the use of any
information in this application to verify my statements, and I authorize above-listed
employers, references and any other persons to answer all questions asked concerning
my ability, character, reputation and previous employment record. I release and hold
harmless all such persons from any liability or damages on account of having furnished
such information. Further I authorize the release of the information provided on this
application to the Southeast Alaska Pilots’ Association to evaluate my qualifications for
selection for a training position.

I understand that a failure to submit a complete application may be grounds for


disqualification from the application process.

I hereby request that personal information contained in this application be kept


confidential and exempted from public records disclosure.

I certify that I have read and understand the instructions to applicants on the SEAPA
website. I acknowledge the availability for download and review from the SEAPA
website the USCG Southeast Alaska Federal Pilotage package; the State of Alaska
Marine Pilot Statutes and Regulations and the Southeast Alaska Pilots’ Association
Training Program Volume I: Trainee Application, Evaluation, and Selection.

I understand that nothing contained in this application or in the authorization to complete


the evaluation and selection process constitutes a promise or guarantee of acceptance
as a Southeast Alaska Pilots’ Association Trainee.

(Printed Name) (Signed Name) (Date)

MAIL COMPLETED APPLICATION AND ALL ATTACHEMENTS TO:

Southeast Alaska Pilots’ Association


1621 Tongass Avenue; Suite 300
Ketchikan, Alaska 99901
Directions: Candidates will assess themselves by circling the points that reflect their various experiences.
Total all points in the point summary section. Provide documentation for all points claimed. Acceptable
documentation includes discharges and letters from the senior management of your company or pilot
association. Submit this form with the Trainee Selection Application.

SOUTHEAST ALASKA PILOT’S ASSOCIATION TRAINEE


CANDIDATE MARITIME EXPERIENCE EVALUATION TOTAL
MAXIMUM POINTS = 115

PILOTING EXPERIENCE (not to exceed a maximum of 30 pts) 100 to 200 201 to 500 Over 500
movements movements movements Served as fully licensed pilot in the
United States or its territories, not a member if the crew, directing and controlling the movement of vessels of not less than 1600
gross tons (minimum one hundred movements) in waters in which a pilot is required by state or federal law. 10 pts 10 pts
10 pts

DEEP DRAFT EXPERIENCE (not to exceed a maximum of 25pts) 1 to 2 Over 2 up Over 5 years to 5 years
years
Master/Command Experience on self-propelled vessels not less than
1600 GRT or 3000 ITC or U.S. commissioned vessels not less than 200
feet length over all. 5 pts 5 pts 5 pts

Chief Mate/Staff Captain/Executive Officer Experience (while holding a USCG license of at least Master ngt 1600 GT) on
self-propelled vessels not less than 1600 GRT or 3000 ITC or U.S. commissioned vessels not less than 200 feet length over all. 0
pts 5 pts 0 pts

Any Master/Command Experience on self-propelled vessels not less than 10000 GRT
(minimum one year, not included with any other experience). 5 pts

Over 2 up Over 5 TUG & TOW VESSEL


EXPERIENCE (not to exceed maximum 25 pts) 1 to 2 years to 5 years years

Master/Command Experience on Tugs conducting ship assist work. 0 pts 5 pts 0 pts

Master/Command Experience on Tugs with Town combined tonnage greater than 1600 GRT (minimum one year not included with
any other experience). 5 pts 5 pts 5 pts

Chief Mate/Second-in-Command Experience on Tugs with Tows combined tonnage greater than 1600 GRT (minimum one year not
included with any other experience). 0 pts 5 pts 0 pts

ALASKA EXPERIENCE (not to exceed a maximum of 20 pts) 1 to 5 years Over 5 years

Master/Command Experience in Alaska (minimum one year). 5 pts 5 pts

Any SEAK Full Core SEAK


Federal Pilotage Federal Pilotage Endorsement of First-Class
pilotage without tonnage restrictions for Southeast Alaska. 2 pts 8 pts

Over 2 yrs RECENCY OF EXPERIENCE (not to


exceed a maximum of 15 pts) 1 to 2 yrs to 4 yrs Over 4 yrs
w/in the w/in the w/in the Any of the above experience that is within
the 7 years immediately previous 7 yrs previous 7 yrs previous 7 yrs Preceding the application (differing experience w/in the
allowable Timeframe is cumulative). 5 pts 5 pts 5 pts

POINT SUMMARY: Piloting Experience total (not to exceed a maximum of 30 pts): __________pts Deep Draft Experience (not
to exceed a maximum of 25 pts): __________pts Tug & Tow Vessel Experience (not to exceed a maximum of 25 pts):
__________pts Alaska Experience (not to exceed a maximum of 20 pts): __________pts Recency of Experience (not to exceed a
maximum of 15 pts): __________pts TOTAL POINTS: __________points