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Drivers Declaration Form

1About You
2Driving History
3Upload a copy your license
4Acknowledgements
This field is for validation purposes and should be left unchanged.

About You

Please give us your personal contact information in this section. We will only use this in the event of notifying our insurers of your details in the event of an accident, or the police if we receive a notice of intended prosecution.
Name(Required)
Date Of Birth(Required)
Your Address(Required)

Driving History

Please give us your personal driving history and licence information. This should match what you have already submitted for any personal vehicles you are insured on. We will only use this information to ensure you are fully covered by our motor insurance policy and in the event of notifying our insurers of your details in the event of an accident, or the police if we receive a notice of intended prosecution. Should any of your details change whilst still have use of a Mad Dogs Television vehicle you must update this form and inform us as soon as possible.
What type of driving licence do you have?(Required)
Do you have any medical conditions or disabilities that the DVLA need to know about?(Required)
These include Diabetes, Neurological, Cardiovascular, Psychiatric, Renal, Respiratory and Sleep Disorders
Have you passed any additional driving qualifications?
When did you get this qualification?
Has an insurance provider ever declined, cancelled, or voided your policy or imposed special terms?(Required)
Have you got any unspent non-motoring-related criminal convictions?(Required)
Have you had any motor accidents, claims or losses in the past 5 years, no matter who was at fault or if a claim was made?(Required)
Have you had any driving related convictions, endorsements, penalties, disqualifications or bans in the past 5 years?(Required)
Have you been convicted of serious morting conviction(s) coded AC, BA, CD4, CD5, CD6, CD7, DD, DR, IN, LC, MS, TT, UX or XX in the past 5 years including bans from driving in one or more European Union countries?(Required)

Photograph or scan of your license

Please upload a scan or photograph of your license. If you can include both in one file you may upload it here, or you can upload multiple files or images seperatly.
Drop files here or
Accepted file types: pdf, jpg, jpeg, png, pdf, tiff, doc, docx, , Max. file size: 25 MB, Max. files: 3.

    Acknowledgements

    Please tick the boxes below to acknowledge that the information given is true, and that you accept personal liability whilst you are driving any of our vehicles.
    Statement of truth(Required)
    Drivers conformation(Required)

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    What we're listening to

    Mad Dogs Television
    Mad Dogs Television
    maddogstv
    134,274 Tracks
    As Heaven Is Wide - 2015 Remaster
    As Heaven Is Wide - 2015 Remaster
    Garbage
    2 days ago
    Don't Look Back In Anger - Remastered
    Don't Look Back In Anger - Remastered
    Oasis
    2 days ago
    Dog Days Are Over
    Dog Days Are Over
    Florence + the Machine
    2 days ago

    Where to Find Us

    Mad Dogs Television
    The Dog House
    Pound Lane
    Copythorne
    SO40 2PD

    Office Hours

    Monday - Friday:
    9:30am - 5pm

    Get in touch

    Email: hello@maddogs.tv
    Phone: 02380 813847

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    © Copyright MMXXV Maddogs Television Limited
    Registered in England and Wales | Company No: 05390817 | VAT No: GB857612503 | All Rights Reserved

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    Training Course Booking Request

    To book in your training please complete the form below. We'll get back to you at the details provided to confirm if your prefered day is available and answer any questions you may have.

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    Work Experience Request

    To request work experience with us please complete the following form.

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    Your Personal Information

    Your Name(Required)
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    When is the best time for us to reach you via telephone?

    Current Education Level

    What level are you currently studying?(Required)
    Hours You Are Available(Required)
    Monday
    Tuesday
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    Please tell us what hours you are available for work experiance each day of the week. Note our standard office hours are 9:30 to 5

    Previous Employment

    Your Previous Employers
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    Dates (From/To)
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    Reference Details
     
    Please list your contact information for any previous or current employers/work experience placements, if applicable. You may leave this section blank if you’ve never had prior work experience placements or employment.

    More About You

    Please use this section to tell us a little about yourself, your cover note in effect. Why are you interested in undertaking work experience with us and what you hope to get out of it.
    Please use this section to tell us a little more about the technical areas you are currently studying and what profession you're looking to go into once you finish your studies.
    Accepted file types: pdf, doc, docx, Max. file size: 25 MB.
    Please upload your a recent copy of your CV in .pdf, .doc or .docx format

    Availability

    If you are looking for a specific date for your work experience please tell us here. If you have a flexibility and can offer us range of potential dates, please select the earliest and latest that you would be available.
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    Acknowledgments

    Handling of personal data(Required)
    Acknowledgement statement(Required)

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    Freelancers Talent Pool

    To request inclusion in our freelancer talent pool please complete the following form.

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    Your Personal Information

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    Skillset

    What role skills/roles would you like to be considered for?
    Let us know all the apply for you, or if your skillset isn't listed, please use the about you section below to expand upon your skillset.

    More About You

    Please use this section to tell us a little about yourself, your cover note in effect. Why are you interested in working alongside us, where you are based, any equipment you own or are familiar with etc.
    Accepted file types: pdf, doc, docx, Max. file size: 25 MB.
    Please upload your a recent copy of your CV in .pdf, .doc or .docx format

    Acknowledgments

    Handling of personal data(Required)
    Acknowledgement statement(Required)