ESCAPEPlease read the form carefully, including the terms and conditions

before completing. PLEASE also attach a recent photograph . Can you escape from a remote location using just your engineering skills and ingenuity? If you think you can, we want you to apply for Channel 4’s brand new ultimate engineering challenge to test you to the limit. Dropped in a remote and undisclosed location a small team of engineers will have only their imagination, resourcefulness and what they can find from the debris of a crash to create a vehicle to escape from the scene.  With a finite amount of food and water they must work fast to create a vehicle that will help them escape the challenging environment and reach civilization. They can’t just survive. They must ESCAPE.If you think you have what it takes to do the impossible then we want to hear from you.

Please send your application in as soon as you can, but by no later than 28 February 2017. All applications received before the deadline will be considered.

If your application has been successful for the next stage of casting, you will be telephoned by one of the production team.

Try to tell us as much as you can about your engineering experience. Be as honest as possible – we are looking for people with varying amounts of experience.

You need to also consider the extreme nature of the programme. You will be subject to mental and physical challenges.

If you have not heard from us by the 1st July 2017 then your application has not been successful. Unfortunately, due to the volume of entries we will not be able to reply individually to every application or answer specific questions about them. Please email completed forms to: casting@mavericktv.co.uk or post to: Escape, Maverick Television, 3-7 Ray Street, Farringdon, London. EC1R 3DR. Email is preferred.

Part 1: Personal Details

Name

Age / Date of birth

Address and Postcode

Email

Social Media URLs

Mobile

Home Tel

What is your living situation? (married, co-habiting, living with parents, single etc.)

Do you have any children? (If so please tell us their names and ages)

What is your current occupation?

Please list any previous occupations

Availability

Are you away anytime between March and July 2017? (If so, please give dates of

unavailability)

Do you have a valid UK Passport?

What date does it expire?

If you are successful after the first stage of the application process you will be required to attend an assessment in the UK on a date TBC. Can you make yourself available?

Do you have any criminal convictions or pending criminal charges? (If yes, please give details. This will not necessarily exclude you from taking part in the programme)

Have you been on TV or in the press? (If you have, please state show names and dates, or details of articles. This will not necessarily exclude you from taking part in the programme)

Where did you hear about the programme?

Part 2: Experience & Training

Qualifications and courses completed (to include health & safety qualifications)

How have you used your engineering experience in everyday life?

Any home creations?

What are you most/least comfortable working on – Mechanics, systems, vehicle types etc.

Which vehicles do you have experience driving? E.g. Motorbikes, snowmobiles, sailboats, planes.

Please give details of level of experience and frequency of use.

PLEASE RATE YOUR ABILITY AT THIS SKILL OR PRACTISE (1 – 5) Highly skilled 5Skilled 4Moderate 3Some familiarity: 2No experience: 1*PLEASE NOTE NOT ALL OF THESE SKILLS ARE REQUIRED – WE ARE LOOKING FOR VARYING AMOUNTS OF EXPERIENCE*

CNC / MILLING

LATHE

STAMPING / PUNCHING

FOLDING

WOODWORK

MIG WELDING

TIG WELDING

STICK WELDING

PLASTIC FORMING

FIBREGLASS

CARBON

CUTTING WITH GRINDER

SHAPING WITH GRINDER

CUTTING WITH PLASMA

CUTTING WITH OXY

MEASURING AND ACCURACY

USE OF HAND TOOLS AND COMMON POWER TOOLS (Drills, recip saws, chop saws etc.)ELECTRIC MOTORS AC DCGENERAL ENGINE MECHANICS (assembly, fault finding, installation, matching)

MAPPING

DIAGNOSTIC FAULT FINDING

HYDRAULICS DESIGN

HYDRAULICS FITTING

PNEUMATICS DESIGN

PNEUMATICS FITTING

ELECTRICS CIRCUITS DC (looms, fault finding)

CIRCUIT DESIGN DC

FREE HAND DRAWING / SKETCH

CAD SOFTWARE

AERODYNAMIC DESIGN

STRUCTURAL DESIGN

FORCES

CALCULATIONS / MATHS

KNOWLEDGE OF MECHANISMS / PARTS

PRESSURE VESSELS

TYRE CHOICE

STEERING

GEARBOXES

WHEELS

RUDDERS / FLAPS

BRAKES (LIST TYPES)

CHAIN DRIVE

LINKAGES

CRANKS AND RACHETS

SUSPENSION

CAMS

VEHICLE TYPES / ENGINES WORKED ON

TRACKED

MOTORBIKE

CARS

BOAT INBOARD ENGINE

BOAT OUTBOARD ENGINE

PWC / JET PUMP

AERO JET ENGINES

PROP ENGINES

How strong a swimmer are you? (please give details)

Do you have any other skills that might be useful for us to know about e.g. Skiing? Climbing?

Any unusual skills/qualifications?

In your opinion does a team need a leader?

In your opinion who would be the best 4 other people in your team?

Any phobias or major fears we should know about?

E.g. heights, claustrophobia

Why do you think you would be a good candidate for Escape

(100 words or less)

What is the greatest challenge you have succeeded at and why?

How would your friends describe your personality?

Is there any additional information about yourself you feel might aid your application?

Is there anything about you and your potential participation that could bring you, Maverick Television or Channel 4 into disrepute?

Application Rules

1. You must be aged 18 or over.

2. You must be resident of the UK (inc Isle of Man and Channel Islands).

3. You must have a valid passport with at least SIX months remaining before expiry from July 2017

4. You must be able to commit to an approximate ten day filming period which is currently expected to be between March and July 2017. These may be weekdays and weekends.

5. You must not be, or be closely related to, a member of Channel 4 / Maverick TV staff or anyone connected with the programme.

6. Details of unspent convictions should be listed on the application form. This does not necessarily exclude you from applying but Channel 4 would need to know.

7. Please advise the production team if you have had any complaints against you in the past and if they have been actioned or resolved.

8. Please be aware that if you have been shortlisted, you will need to complete a Disclosure Barring Check (previously called CRB) which you will be reimbursed for any incurred fees by the production.

9. If you are selected you will be required to visit your GP and obtain your full medical records, as well as undergo a medical and fitness examination prior

Do you have any medical conditions that could affect your participation in the programme? (successful candidates will be required to undergo a full physical exam, psychological evaluation and to disclose their medical history)

to filming. You will have a consultation with the programme psychologist / psychiatrist to assess whether you are suitable for the programme and to discuss the intense nature of Special Forces training. You will also be asked to take part in an engineering ‘test’ to ensure you have some of the relevant skills required to take part in the series.

10. If you are chosen to participate in the Programme, you agree to authorise Maverick TV to conduct background checks in order to verify any of the information you have supplied and you agree to provide them with any assistance or further information necessary to do this.

11. Submission of an application form and compliance with the above does not in any way constitute an offer to appear on the programmes.

12. When selecting applicants for this series, the following will be taken into account: fitness, enthusiasm, drive, personality, diversity, mental strength. Initial selection will be based on the application forms and telephone interviews. In addition the Producers may (but may not) invite short listed applicants to attend an interview at their discretion. We will be looking for a mix of contributors to reflect the range in age, location, mental and physical ability of people.

13. If you are selected to take part in the programme you agree to sign a contributor consent form and grant all necessary rights.

14. The Production team's decisions regarding selection to the programmes are entirely at their discretion and are final.

15. You agree to inform Maverick TV if any details included in this application change.

16. Please note, no cash prize will be awarded for completion of the programmes.

Please note – owing to the large volume of applications we receive, we are unable to respond to any unsuccessful applicants directly.

Important information about the use of your data1. Personal information which you supply to Maverick TV during the application, audition and casting process will only be used in association with the development and/or production of the programme and your participation therein.

2. Your personal information will be shared with members of the programme production team and relevant staff at the broadcaster of the programme and may be shared with Maverick TV and/or the broadcaster’s insurers.3. Maverick TV will ensure that any information provided for the purpose of producing the programme will be used in accordance with the Data Protection Act 1998.4. All information will be kept secure and treated as confidential and will only be disclosed with your permission (including any permissions you give here or in the rest of the application process). In submitting this application form you are consenting to us using your personal information as set out in this section.

Maverick TV finds it useful where possible to retain on file the personal details of its contributors for future related use when, for example, producing similar programmes. Please note that if you agree to this, Maverick TV may contact you separately regarding other projects. Your refusal to grant us such permission will in no way influence our decision as to whether or not we use your application form, your information or you in the Programme.

Please mark the box below to declare you are happy for this to happen:

If you do not consent to future use of your information and you are not selected to participate in the Programme, your application form will be securely destroyed after two years.

Important: Please read the following carefullyI confirm that to the best of my knowledge and belief the answers I have provided are accurate and true. I understand that the supply of any knowingly inaccurate, misleading or false information in this form would lead to my disqualification from taking part in the programme. I confirm that I have all necessary permissions to supply the information (including any personal data) and materials provided and understand that completion of this form does not in any way guarantee appearance in the programme or any further correspondence from Maverick TV. I will update the production throughout the whole period before and during filming and also before broadcast if anything changes.By submitting this form, you hereby confirm that you have read and understood its terms and that to the best of your knowledge and belief the answers you have provided are accurate and true. You understand that the supply of any knowingly

inaccurate, misleading or false information in this form would lead to your disqualification from taking part in the programme. You confirm that you have all necessary permissions to supply the information and materials provided and understand that completion of this form does not in any way guarantee your appearance in the programme or any further correspondence from Maverick TV.

Read and agreed by

_________________

Date of signature: