Form DBPR BOPC1 "Application for Harbor Pilot Examination" - Florida

What Is Form DBPR BOPC1?

This is a legal form that was released by the Florida Department of Business & Professional Regulation - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 21, 2012;
  • The latest edition provided by the Florida Department of Business & Professional Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DBPR BOPC1 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

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Download Form DBPR BOPC1 "Application for Harbor Pilot Examination" - Florida

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State of Florida
Department of Business and Professional Regulation
Board of Pilot Commissioners
Application for Harbor Pilot Examination
Form # DBPR BOPC 1
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
Submit a non-refundable fee in the amount of $200 per port. (Make check
payable to Department of Business and Professional Regulation.)
Submit a copy of your high school diploma, GED or college diploma.
Deputy Pilot
Submit a Merchant Mariner Physical Examination Report which was
administered by a licensed physical within the proceeding 6 months.
Certificate by
Examination
Submit documentation verifying that the applicant has been subject to a
random drug testing program within the past 6 months.
Submit a copy of your Merchant Mariner’s license with all current
licenses/endorsements.
Submit a non-refundable fee in the amount of $200 per port. (Make check
Cross-Licensed
payable to Department of Business and Professional Regulation.)
Deputy Pilot
Submit a copy of your Merchant Mariner’s license with all current
Certificate by
licenses/endorsements.
Examination
Submit a non-refundable fee in the amount of $200. (Make check payable
State Pilot License
to Department Business and Professional Regulation.)
by Examination
Submit a copy of your Merchant Mariner’s license with all current
licenses/endorsement
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation/Board of Pilot Commissioners
P.O Box 5377
Tallahassee, Fl 32314-5377
NOTE:
The Department will only accept applications for Deputy Pilots when there is a declared
opening. Please check the DBPR website at
http://www.myfloridalicense.com/dbpr/pro/pilotc/index.html
for current openings before
submitting your application. Physical examination reports must be submitted with your
application by using the Merchant Mariner Physical Examination Report, which can be
found on the DBPR website, and MUST include drug test results within the past 6 months.
DBPR BOPC 1 Application for Harbor Pilot Examination
Incorporated by Rule 61-35.018
Effective 08/21/2012
1 of 8
State of Florida
Department of Business and Professional Regulation
Board of Pilot Commissioners
Application for Harbor Pilot Examination
Form # DBPR BOPC 1
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
Submit a non-refundable fee in the amount of $200 per port. (Make check
payable to Department of Business and Professional Regulation.)
Submit a copy of your high school diploma, GED or college diploma.
Deputy Pilot
Submit a Merchant Mariner Physical Examination Report which was
administered by a licensed physical within the proceeding 6 months.
Certificate by
Examination
Submit documentation verifying that the applicant has been subject to a
random drug testing program within the past 6 months.
Submit a copy of your Merchant Mariner’s license with all current
licenses/endorsements.
Submit a non-refundable fee in the amount of $200 per port. (Make check
Cross-Licensed
payable to Department of Business and Professional Regulation.)
Deputy Pilot
Submit a copy of your Merchant Mariner’s license with all current
Certificate by
licenses/endorsements.
Examination
Submit a non-refundable fee in the amount of $200. (Make check payable
State Pilot License
to Department Business and Professional Regulation.)
by Examination
Submit a copy of your Merchant Mariner’s license with all current
licenses/endorsement
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation/Board of Pilot Commissioners
P.O Box 5377
Tallahassee, Fl 32314-5377
NOTE:
The Department will only accept applications for Deputy Pilots when there is a declared
opening. Please check the DBPR website at
http://www.myfloridalicense.com/dbpr/pro/pilotc/index.html
for current openings before
submitting your application. Physical examination reports must be submitted with your
application by using the Merchant Mariner Physical Examination Report, which can be
found on the DBPR website, and MUST include drug test results within the past 6 months.
DBPR BOPC 1 Application for Harbor Pilot Examination
Incorporated by Rule 61-35.018
Effective 08/21/2012
2 of 8
Instructions
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
1. Application Instructions (by section)
a. Section I- Application Type
i.
Check only one of the application types.
b. Section II- Applicant Information
i.
Fill out each section completely. A Social Security number is required in order to apply
for any individual license within the Department of Business and Professional Regulation.
ii.
In the “FULL LEGAL NAME” section, provide your full legal name as it appears on your
Social Security card. Do not use any nicknames or initials. Please list any aliases or
prior names in the prior name information section.
iii.
Provide your mailing address. This will be used for sending correspondence regarding
your application and license.
iv.
Contact information is often used to quickly resolve questions with applications by
telephone call or email. If contact information is not provided, questions regarding
applications will be mailed to the applicant’s mailing address and may take longer to
resolve.
v.
Additional contact information is optional and will be used when the applicant cannot be
reached using their primary contact information.
vi.
Applicants must provide information on current or prior licenses held in Florida or any
other state, territory, or jurisdiction of the United States or in any foreign national
jurisdiction.
vii.
Applicants must provide information on any prior names or aliases used by applicant. If
the name on supporting documentation does not match the applicant’s legal name, the
alias used in the supporting documentation must be provided in this section. Failure to
do so will result in a deficient application.
c. Section III – Pilot License or Endorsement
i.
Provide copies of any pilot license you currently hold, if any, including any U.S. Coast
Guard license or endorsement. Please provide a copy of the front and back.
d. Section IV – Background Information
i.
Answer each question completely. Provide copies of you high school diploma, college
diploma or GED.
e. Section V (a), (b), and (c)- Background Questions
i.
Applicants must submit answers to each of the background questions.
ii.
Question 1:
(1)
If you answer “yes” to this question, you must complete Section V (b) [make
additional copies as necessary] of the application and provide a copy of the arrest
report, copies of the disposition or final order(s), and documentation proving all
sanctions have been served and satisfied. You must supply this documentation
for each occurrence. If you are unable to supply this documentation, a certified
statement from the clerk of court for the relevant jurisdiction stating the status of
records is required.
(2)
If you are still on probation, you must supply a letter from your probation officer, on
official letterhead, stating the status of your probation.
iii.
Question 2:
(1)
If you answer “yes” to this question, you must complete Section V (b) [make
additional copies as necessary] of the application and provide a copy of the judgment
or decree. You must also supply documentation proving all sanctions have been
served and satisfied, or if not, stating the current status of any proceedings.
iv.
Question 3:
(1)
If you answer “yes” to this question, you must complete Section V (c) [make
additional copies as necessary] of the application and supply copies of
documentation explaining the denial or pending action.
v.
Question 4:
(1)
If you answer “yes” to this question, you must complete Section V (c) [make
additional copies as necessary] of the application and supply copies of the order(s)
showing the disciplinary action taken against the license, or documentation showing
the status of the pending action.
f.
Section VI- Maritime Experience
DBPR BOPC 1 Application for Harbor Pilot Examination
Incorporated by Rule 61-35.018
Effective 08/21/2012
3 of 8
i.
Please review the requirements for the Maritime Experience listed below. Submit
documentation regarding your experience through discharge, continuous discharge
books, or other official documents.
g. Section VII – Affirmation by Written Declaration
i.
Please read and sign the affirmation by written declaration.
ii.
If the applicant fails to sign the affirmation statement, the Department will not process the
application.
MARITIME EXPERIENCE REQUIRED FOR DEPUTY PILOT
Submit full documentation of sea time through discharges, continuous discharge books, or other official
documents. Applicant must have at least 2 years of experience (600 days) in either total or combination of
the following. No combination amount may be less than 60 days; 1 year equals 300 days.
Within the past 5 years, at least 2 years of service at sea, 1 year in at least the capacity of an
unlimited second mate.
Within the past 5 years, at least 2 years of service in a deepwater US port as an active first-class
unlimited pilot serving on at least an unlimited second mate’s license or a license as master of
freight and towing vessel of at least 1,600 GRT upon oceans, and acting under authority of a duly
constituted governmental regulatory entity.
Within the past 5 years, at least 2 years of service as an active first-class unlimited pilot serving
on a Great Lakes unlimited master’s license.
Within the past 5 years, at least 2 years of service as a master of a tugboat/barge combination of
at least 5,000 GRT, combined tonnage, while holding a license as master of freight and towing
vessel of at least 1,600 GRT upon oceans.
Within the past 10 years, at least 3 years of service as a deck watch officer, 1 year of which in the
5 year period preceding examination must have been as the commanding officer, executive
officer, or operations officer of a USN vessel or a USCG vessel of at least 1,600 GT and must
currently hold a USCG license of at least an unlimited second mate.
DBPR BOPC 1 Application for Harbor Pilot Examination
Incorporated by Rule 61-35.018
Effective 08/21/2012
4 of 8
State of Florida
Department of Business and Professional Regulation
Board of Pilot Commissioners
Application for Harbor Pilot Examination
Form # DBPR BOPC 1
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
For additional information see the Instructions at the beginning of this application.
Section I - Application Type
CHECK ONE OF THE APPLICATION TYPES
Deputy Pilot Certificate by Examination [2301/1010]
Cross-Licensed Deputy Pilot Certificate by Examination [2301/1012]
 State Pilot License by Examination [2302/1010]
Port area you are requesting examination for:
Section II – Applicant Information
APPLICANT INFORMATION
Social Security Number*
FULL LEGAL NAME
Last/Surname
First
Middle
Suffix
Birth Date (MM/DD/YYYY)
Gender
 Male  Female
/
/
Race/Ethnicity (check only one):
 Black or African American
 Asian or Pacific Islander
 Native American or Alaskan Native
 White or Caucasian
 Spanish, Hispanic or Latino
 Other
MAILING ADDRESS
Street Address or P.O. Box
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
CONTACT INFORMATION
Primary Phone Number
Primary E-Mail Address
ADDITIONAL CONTACT INFORMATION (OPTIONAL)
Alternate Phone Number
Fax Number
Alternate E-Mail Address
* The disclosure of your Social Security number is mandatory on all professional and occupational license applications, is solicited
by the authority granted by 42 U.S.C. §§ 653 and 654, and will be used by the Department of Business and Professional Regulation
pursuant to §§ 409.2577, 409.2598, 455.203(9), and 559.79(3), Florida Statutes, for the efficient screening of applicants and
licensees by a Title IV-D child support agency to assure compliance with child support obligations. It is also required by § 559.79(1),
Florida Statutes, for determining eligibility for licensure and mandated by the authority granted by 42 U.S.C. § 405(c)(2)(C)(i), to be
used by the Department of Business and Professional Regulation to identify licensees for tax administration purposes.
DBPR BOPC 1 Application for Harbor Pilot Examination
Incorporated by Rule 61-35.018
Effective 08/21/2012
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Section II – Applicant Information – continued
CURRENT/PRIOR LICENSE INFORMATION
If you currently hold or have previously held a business or professional license/registration in Florida or
elsewhere, please list each one below (attach additional copies of this page as necessary):
Date (From)
Date (To)
1. License/Registration Type
State
/
/
/
/
License Number
Name Used
Date (From)
Date (To)
2. License/Registration Type
State
/
/
/
/
License Number
Name Used
Date (From)
Date (To)
3. License/Registration Type
State
/
/
/
/
License Number
Name Used
PRIOR NAME INFORMATION
Have you used, been known as, or are currently known by another name (e.g., maiden name or
nickname) or alias other than the name signed to the application? 
Yes
No
If your answer is yes, state name or names used below:
Last/Surname
First
Middle
Suffix
Last/Surname
First
Middle
Suffix
Last/Surname
First
Middle
Suffix
Section III – Pilot License or Endorsement
PILOT LICENSE OR ENDORSEMENT
List below all (if any) pilot licenses, certificates or endorsements you hold. Provide a copy (front and back)
of each one listed, including U. S. Coast Guard or endorsement.
Section IV – Background Information
BACKGROUND INFORMATION
 Yes  No
Are you addicted to the use of drugs or alcohol?
 Yes  No
Do you have a high school diploma or GED?
 Yes  No
Have you ever taken an examination for a Deputy Pilot position in Florida?
If yes, please indicate the date, the port and your overall score.
Date:
Overall Score:
Port:
Date:
Overall Score:
Port:
Date:
Overall Score:
Port:
DBPR BOPC 1 Application for Harbor Pilot Examination
Incorporated by Rule 61-35.018
Effective 08/21/2012
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