CAPTAIN PROFILE
General Information
Last Name:
_________________________________________________________________
First Name:
_________________________________________________________________
Preferred Name:
_________________________________________________________________
Company Name:
_________________________________________________________________
Mobile Number:
_________________________________________________________________
Gender:
Male ☐
Female ☐
Billing Address:
Street: ___________________________________________________________
Apt/PO/Suite: ____________________________________________________
City:
___________________________________________________________
State: ___________________________________________________________
Zip:
___________________________________________________________
Physical Location:
If different than mailing address
City: ________________________________________________
State: ______________________________________________
Desired Work Location(s):
City:
___________________________________________________________
State: ___________________________________________________________
City:
___________________________________________________________
State: ___________________________________________________________
City:
___________________________________________________________
State: ___________________________________________________________
LICENSES & CERTIFICATIONS
Issuing Agency (check all that apply):
USCG Deck Rating:
OUPV ☐
Navigable Waters Rating:
50T ☐
RYA ☐
100T ☐
Near Coastal: ☐
Endorsements (check all that apply):
License Number:
USCG ☐
Towing ☐
200T ☐
500-1600T ☐
Inland: ☐
Sail ☐
___________________________________________________________
License Original Issuance Date: ___________________________________________________________
License Expiration Date:
RYA Deck Rating:
___________________________________________________________
200T ☐
License Number:
500T ☐
3000 ☐
Other ☐
___________________________________________________________
License Original Issuance Date: ___________________________________________________________
License Expiration Date:
___________________________________________________________
USCG Engineer Rating: Asst. Engineer ☐
License Number:
Chief Engineer ☐
___________________________________________________________
License Original Issuance Date: ___________________________________________________________
License Expiration Date:
___________________________________________________________
Engineering Proficiency:
Beginner ☐
Novice ☐
Other Certifications/Education (check all that apply):
Other:
Expert ☐
STCW ☐ Radar ☐
EMT ☐ Scuba ☐
________________________________________________________________________
________________________________________________________________________
WORK PROFILE
Work Preference (check all that apply): Cruising ☐
Fishing ☐
Delivery ☐
Training ☐
Employment Desired (check all that apply): Full Time ☐
Part Time ☐
Availability: Immediate ☐
Longer Term (1-4 months) ☐
Near Term (1-4 weeks) ☐
Contract ☐
Desired Compensation:
Hourly:
$__________________ p/hr
Annual Salary:
$__________________ p/yr
Delivery Day Rate:
$__________________ p/dy
VESSEL TYPE EXPERIENCE
Engine Type (all that apply): Outboard ☐ Inboard ☐ Inboard/Outboard ☐ Jet Drive ☐ Pod Drive ☐
Number of Engines (check all that apply): Single Engine ☐
Twin Engine ☐
Vessel Structure (check all that apply): Coupe ☐ Flybridge ☐ Center Console ☐ Bowrider ☐
COMMAND EXPERIENCE
Coastal Cruising (less than 50nnm offshore)
List all vessels previously/currently under command:
_________________________ ________
Manufacturer
Yr of Build
_________________________ ________
Manufacturer
Yr of Build
_________________________ ________
Manufacturer
Yr of Build
_________________________ ________
Manufacturer
Yr of Build
_________________________ ________
Manufacturer
Waters Navigated:
Yr of Build
_______
______________
_____________
Length
Hours Underway
Employment Year(s)
_______
______________
_____________
Length
Hours Underway
Employment Year(s)
_______
______________
_____________
Length
Hours Underway
Employment Year(s)
_______
______________
_____________
Length
Hours Underway
Employment Year(s)
_______
______________
_____________
Length
Hours Underway
Employment Year(s)
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Offshore Cruising (greater than 50nm offshore)
List all vessels previously/currently under command:
_________________________ ________
Manufacturer
Yr of Build
_________________________ ________
Manufacturer
Yr of Build
_________________________ ________
Manufacturer
Yr of Build
_________________________ ________
Manufacturer
Waters Navigated:
Yr of Build
_______
______________
_____________
Length
Hours Underway
Employment Year(s)
_______
______________
_____________
Length
Hours Underway
Employment Year(s)
_______
______________
_____________
Length
Hours Underway
Employment Year(s)
_______
______________
_____________
Length
Hours Underway
Employment Year(s)
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Vessel Delivery
List all vessels under command:
_________________________ ________
Manufacturer
Yr of Build
_________________________ ________
Manufacturer
Yr of Build
_________________________ ________
Manufacturer
Yr of Build
_________________________ ________
Manufacturer
Waters Navigated:
Yr of Build
_______
______________
_____________
Length
Hours Underway
Employment Year(s)
_______
______________
_____________
Length
Hours Underway
Employment Year(s)
_______
______________
_____________
Length
Hours Underway
Employment Year(s)
_______
______________
_____________
Length
Hours Underway
Employment Year(s)
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
BACKGROUND
Felony Convictions:
Yes ☐
No ☐ If Yes, Please Describe? __________________________
Insurance Claims:
Yes ☐
No ☐ If Yes, Please Describe? __________________________
DUI/BUI:
Yes ☐
No ☐ If Yes, Please Describe? __________________________
OWNER REFERENCES (Vessels you have commanded):
__________________________
Owner Name
__________________________
Owner Name
__________________________
Owner Name
_______________________
________________________
Email
_______________________
Contact Number
________________________
Email
_______________________
Contact Number
________________________
Email
ATTACHMENTS
1. Resume/CV
2. USCG/RYA License photocopy (include photo and endorsement pages)
3. Headshot Photo
Contact Number