Captain Roster Application — Lakeside Yacht Charters

1

Personal Information

First Name Required

Last Name Required

Phone Number Required

Email Address Required

City

State

2

USCG License

License Type Required Master 25 GRT minimum required for 7–12 passenger operations

MMC / License Number

Issue Date

Expiration Date

Tonnage Limit

Endorsements

Great Lakes / Near Coastal Assistance Towing Sail Other (describe in notes)

3

Required Credentials

TWIC Card Status Required

TWIC Expiration Date

Drug Test Status Required

FCC Restricted Radiotelephone Permit

CPR Certification

First Aid Certification

4

Boating Experience

Years on Great Lakes

Vessel Types Operated

Familiarity with Chicago-Area Harbors

Diversey Harbor Belmont Harbor Monroe / DuSable Harbor Burnham Harbor Calumet Harbor Other (note below)

Experience Summary

5

Professional References

Provide two professional references. Prior charter companies, marina operators, or vessel owners preferred.

Reference 1

Full Name

Relationship

Phone

Email

Reference 2

Full Name

Relationship

Phone

Email

6

Operator Questionnaire

All questions must be answered truthfully and completely. Disqualifying responses will result in automatic denial. False statements are grounds for immediate removal from the roster.

Q1. Do you have a minimum of 2 years of experience operating vessels between 30 and 50 feet in length?

Yes No

This response is a disqualifying factor. A minimum of 2 years experience on 30–50 ft vessels is required for roster eligibility.

Describe your experience on vessels in this size range

Q2. Have you been involved in any marine losses, groundings, collisions, or insurance claims in the past 10 years?

No Yes

Any marine losses in the past 10 years is a disqualifying factor. Your application will not be approved.

Describe each incident — date, circumstances, and outcome

Q3. Have you had any maritime or motor vehicle violations, license suspensions, or revocations (including automobile) in the past 5 years?

No Yes

Any violations or suspensions (maritime or automotive) in the past 5 years is a disqualifying factor. Your application will not be approved.

Describe each violation — date, type, jurisdiction, and outcome

Q4. Have you ever been convicted of a crime, or entered a plea of no contest (nolo contendere) to any criminal charge — at any time?

No Yes

Any criminal conviction or no-contest plea is a disqualifying factor. Your application will not be approved.

Describe the charge(s), jurisdiction, plea, and sentence

Q5. Do you consent to Lakeside Yacht Charters verifying and documenting all stated credentials prior to any departure being authorized?

Yes No

Consent to credential verification is required. Captains who do not consent are not eligible for the roster.

7

Acknowledgment & Agreement

By submitting this application, I confirm that all information provided is accurate, complete, and truthful. I understand that any misrepresentation — including omissions — is grounds for immediate removal from the Lakeside Yacht Charters captain roster. I understand that inclusion on this roster does not constitute employment or a guarantee of engagement. Any work performed with a charterer is an independent contractor arrangement between myself and the charterer directly. Lakeside Yacht Charters bears no liability for the captain-charterer relationship. I consent to credential verification, background check, and driving record review as part of this screening process, and I acknowledge that all credentials must be verified and documented by Lakeside Yacht Charters before any departure is permitted.

I have read and agree to the terms above.

Sending...

Application Received