Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 2Deputy Pilot Application Qualifications Be at least twenty-five (25) years of age. Be a United States citizen. Be of good moral character. Possess the requisite skill as a navigator to perform safely and competently the duties of a Deputy Pilot. Hold at the minimum a valid U.S. Coast Guard license as Master 1600 Gross Tons (Inland, Near Coastal, or Oceans) or U.S. Coast Guard license as Chief Mate Unlimited Tonnage (Near Coastal or Oceans). Hold a valid Radar Observer (Unlimited) certification. Be of good mental and physical health sufficient to perform the duties of a ship pilot. Be eligible to receive a U.S. Coast Guard First Class Pilot License (Unlimited Tonnage) for the Brownsville Ship Channel from Brazos Santiago Pass Sea Buoy to the Brownsville Turning Basin and the Port Isabel Turning Basin, Texas. ContinueName *LayoutEmail *Age:Date of Birth: *Phone *SSN: *Driver's License No: *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCITIZENSHIP / RESIDENCYLayoutU.S. Citizen? *Please SelectYesNoHave You Resided in the state of Texas for a continuous period of not less than one year? *Please SelectYesNoDate Period of Continuous Residence began?EducationLayoutHighest Grade Completed? *Please SelectGrade SchoolHigh schoolUniversity of CollegeGraduate SchoolDid You Graduate? *Please SelectYesNoPlease List School Names, Location, Degrees and date attended *Military ServiceLayoutHave you served in the Armed Forces? *Please SelectYesNoBranchDate EnteredDate ReleasedService NumberRank of releaseEMPLOYMENTLIST PREVIOUS EMPLOYMENT HISTORY *Please indicate dates, duties, position held and reason for leaving and the name and telephone number of a person who can confirm this information.SEA EXPERIENCEPLEASE LIST YOUR SEA EXPERIENCE *SHOW POSITIONS WITH YEARS SERVEDCOAST GUARD LICENSENOTE: Applicants are required to verify a valid U.S. Coast Guard license as Master 1600 Gross Tons (Inland, Near Coastal, or Oceans) or U.S. Coast Guard license as Chief Mate Unlimited Tonnage (Near Costal or Oceans)WHAT US COAST GUARD LICENSE DO YOU HOLD? INDICATE NONE IF NONE.PLEASE UPLOAD A PHOTO COPY FRONT & BACK * Click or drag a file to this area to upload. HAS THE COAST GUARD OR OTHER APPROPRIATE BODY EVER TAKEN ANY PRECEEDING AGAINST YOU LICENSE? *Please SelectYesNoPlease indicate findings determined by appropriate bodies. Applicants for branch pilot renewals may limit history of incidents to the previous four years.PHYSICIANS EXAMINATIONA CURRENT REPORT OF A PHYSICIAN'S EXAMINATION MUST BE INCLUDED WITH THE APPLICATION. CG719K FORM MERCHANT MARINER CREDENTIALS MEDICAL EVALUATION REPORT.File Upload Click or drag a file to this area to upload. RELATIONSHIP TO OTHER PILOTSPLEASE LIST IF YOU ARE RELATED BY BLOOF OR BY MARRIAGE TO OTHER BRAZOS SANTIAGO PILOTS (IF ANY)If Yes, please list Name and RelationshipPERSONAL REFERENCESLIST THREE PERSONS (NOT RELATED TO YOU) WHOM YOU HAVE KNOW FOR FIVE YEARS OR LONGER AND HAVE DEFINITE KNOWLEDHE OF YOUR CHARACTER AND FITNESS *Pease indicate name, address, current phone number, and profession.CRIMINAL RECORDNOTE: Drug and alcohol incidents/usage are heavily scrutinized. Please note that a full criminal history background check will be conducted.HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL PROCEEDING? *PLEASE SELECTYesNoEXCLUDING TRAFFIC VIOLATIONS, PLACED ON PROBATION, REQUIRED TO PERFORM COMMUNITY SERVICE, OR HAD A CRIMINAL PROCEEDING DISAPOSED OF BY PRE-TRIAL DIVERSION, DIFFERED PROSECUTION, DEFERRED ADJUDICATION, OR SIMILAR PROCEEDINGSEXPLAIN BELOWIF YES, PLEASE EXPLAIN ABOVE. NOTE: A CONVICTION DOES NOT AUTOMATICALLY DISQUALITY YOU. THE FACTS MUST BE CONSIDERED. PLEASE GIVE A FULL EXPLANATION.APPLICATION ACKNOWLEDGEMENTI HEREBY SUBMIT MY APPLICATION FOR DEPUTY BRANCH PILOT AND WILLINGLY SUBMIT THE FOLLOWING:AUTHORIZATION *I UNDERSTAND THAT ANY MISREPRESENTATION OR OMISSION OF FACTS CALLED FOR IS CAUSE FOR REJECTION OR FUTURE DISQUALIFICATIONS.I AGREE TO SUPPLY ANY AND ALL ADDITIONAL INFORMATION REQUESTED TO ASSESS MY APPLICATION.I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION AND RELEASE THE PILOT BOARD, THE APPLICATION REVIEW COMMITTEE, AND THEIR STAFF FROM LIABILITY IN CONNECT6ION WITH THEIR INVESTIGATION.Any additional information you would like to add? *LayoutDateSIGNATURESubmit