Application Form
CO Operating Platform
A great business opportunity?
You probably pass it every day
Retailer Business Agreement
Application Form
Shell is committed to delivering excellent customer service and our Retailers play a vital role. To help you achieve
this we will provide you with full training and support and will encourage you to look for every opportunity to use
your skills and talents. This is your opportunity to tell us as much as possible about yourself. It will help us to make
a fair decision to select the people who can naturally give excellent customer service. Please read the form
thoroughly, then complete it carefully and in your own handwriting or typewritten. Please ensure that you complete ALL
sections.
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CO Operating Platform
PERSONAL DETAILS
Title: ___________________Surname: ______________________________________________________
Forename(s): ____________________________________________________________________
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Home address, including postcode:
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IT IS VITAL WE HAVE A CONTACT NUMBER
Home telephone number: ______________________________________________________________
Mobile number: ___________________________________________________________________
Business telephone number: _____________________________________________________________
Email address: ___________________________________________________________________
Can we contact you at work? Yes/No
If you have lived for less than five years at your current residence, please provide your previous address(es) for this period giving dates:
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Date of birth: ____________________________________________________________________
Do you hold a current driving licence? Yes/No
Are you prepared to relocate? Yes/No
If yes please list geographical areas you would consider moving to (in order of preference):
Preference 1:______________________________________________________________
Preference 2:______________________________________________________________
Preference 3:______________________________________________________________
Are you prepared to do business 6 or 7 day week if necessary? Yes/No
Are you prepared to make a commitment to customer service if appointed? – Yes/No
Are you prepared to commit to the maintenance of strict health, safety and security environmental standards, if appointed? – Yes/No
Are you prepared to run the business within strict operating systems and controls? – Yes/No
Please specify any dates when you would not be available for interview: __________________________________________________________
How much notice would you require prior to commencing training with us? _______________________________________________________
Have you ever been employed/engaged in a business in the oil industry? Yes/No Where?
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Have you ever been employed by this company? Yes/No
Have you ever been refused a position by this company? Yes/No
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CO Operating Platform
If yes, please provide details:____________________________________________________________
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PLEASE ANSWER THE FOLLOWING QUESTIONS
This section allows you to give us real life examples. Please tell us how you dealt with each of the following situations below.
What did you do, how did you do it and what happened? You can use examples from your work, school, family life or your hobbies.
YOU MUST COMPLETE EACH SECTION OTHERWISE WE CANNOT PROCESS YOUR APPLICATION.
Please give an example of a time when you had to be patient and polite with an individual/group of people (eg. customer, workmate,
friend) under difficult circumstances:
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Please provide an example of when you have made an extra special effort to help somebody:
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CO Operating Platform
Why have you chosen to apply to become a Retailer with Shell, and why do you think you would be suitable
for this type of role?
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Please give an example of when and how you have managed to persuade someone to do something:
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Describe a time when you had to use your initiative to succeed in getting something done properly and on time:
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IF CURRENTLY SELF EMPLOYED
Business/company name and trading address: ___________________________________________________
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Time dedication to current business (hours week): ___________
Industry/business type: _________________________ Estimated annual profit: _________________________
Period of operation: __________________________ Number of employees: __________________________
If you currently run a business of your own, will it be your intention to continue with it? Yes/No If yes, who would run:
a) the current business: _____________ b) this new opportunity: ______________ Time dedication (hours week): _______
FOR BOTH EMPLOYED AND SELF EMPLOYED – CURRENT AND PREVIOUS EMPLOYMENT/
PREVIOUS SELF EMPLOYMENT (Please use a separate sheet if necessary)
Please give details of your employment history starting with your current or most recent position or period of self employment.
Start and Name / Address / Telephone number Position held, achievements and main duties Salary / Reason for leaving
leaving Net Profit or intended leaving
dates
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EDUCATION & TRAINING
School/College/University name Year Results achieved
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Membership of professional bodies, grades and qualifications
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FINANCIAL DATA
NOTE: CREDIT CHECKING IS AN ESSENTIAL REQUIREMENT AND WILL BE UNDERTAKEN THROUGH A LEADING
LOCAL CREDIT REFERENCE AGENCY. THIS WILL NEED TO BE UNDERTAKEN AS PART OF THE APPLICATION PROCESS.
PLEASE CONFIRM YOUR AGREEMENT TO SHELL CONDUCTING A CREDIT CHECK IN ORDER TO PROGRESS YOUR
APPLICATION FURTHER BY SIGNING HERE:
Signed:
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Are you aware of any reason why you would be refused credit? Yes/No
If yes, please give details:
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Do you have or have pending any county court cases against you? Yes/No
If yes, please give details:
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What are your earning aspirations (gross earnings after costs and before income tax) over the next three years? (per annum)
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Please explain how you would fund a minimum investment of Php 3.0Mn to about Php 5.0Mn?
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FINANCIAL DATA (Cont.)
Income Statement
Income statement of the 12 month period ending _____ / _____ / _____
Salary; Wages
Bonuses; Commissions
Dividends; Interest
Real Estate Income
Business Profit (Please specify)
Other Income (Please specify)
TOTAL INCOME
Statement of Net Worth
ASSETS LIABILITIES
Cash in the Bank Accounts, Notes & Loans Payable
Securities/Bonds Real Estate and Mortgages Payable
Accounts, Notes & Loans Receivable Other Liabilities
Real Estate and Mortgages Payable
Other Assets
TOTAL ASSETS TOTAL LIABILITIES
TOTAL NET WORTH (Total Assets minus Total Liabilities)
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REFERENCE CHECKS
CONDITION OF TRAINING/CONTRACT: It is our intention to check all references and information offered by an applicant on this
application form. If it is found after checking that references and/or information provided by the applicant are unsuitable or inaccurate
then the applicant’s training/contract may be terminated without notice.
NOTE: A REFERENCE FROM YOUR CURRENT EMPLOYER WILL ONLY BE REQUESTED AFTER AN OFFER IS MADE AND ACCEPTED.
Please supply details of three referees, one must be your current employer, or if self employed a previous employer or a trade referee such
as a bank manager, solicitor or accountant. If all three referees are not provided, this application will not be considered. If self employed the references
can also be personal
Name:_______________________ Company: __________________ Address:
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E-mail: _____________________ Telephone:
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Name:_______________________ Company: __________________ Address:
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E-mail: _____________________ Telephone:
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Name:_______________________ Company: __________________ Address:
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E-mail: _____________________ Telephone:
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DECLARATION
Do you have any unspent criminal convictions for offences of theft or dishonesty, or do you have a case pending for offences of theft
or dishonesty? Yes/No
If yes, please provide details:
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I hereby declare that all the information given by me and in this application form is true and I agree that Pilipinas Shell Petroleum Corporation may
seek confirmation from appropriate sources. If at any time the information is found to be false or in any way incorrect, any contract
between myself and Pilipinas Shell Petroleum Corp is likely to be terminated without notice.
Signed: ________________________________________ Date:_________________________________
IT IS ESSENTIAL YOU SIGN AND DATE THIS FORM – THANK YOU.
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CO Operating Platform
SOURCE
Please be kind enough to indicate how you became aware of the position of Retailer by ticking one of the following boxes:
ADVERTISEMENT – Please indicate name of publication/website: _____________________________________________________
SHELL RETAILER RECOMMENDATION – Please indicate Retailer’s name: ________________________________________________
SHELL TERRITORY MANAGER – Please indicate name:
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OTHER RECOMMENDATION – Please indicate source: ____________________________________________________________
SPECULATIVE
DATA PROTECTION
1. Shell uses the information the Retailer and/or Applicant provides (1) to operate the Retailer’s account and any agreement with Shell;
(2) to confirm, update and enhance Shell’s customer records; (3) to establish any Retailer and/or Applicant’s identity; (4) for general
statistical analysis; (5) to record and consider the Retailer’s and/or Applicant’s criminal convictions or alleged commission of an offence;
and (6) to assess the Retailer’s and/or Applicant’s credit status (for this purpose, credit scoring techniques will be used and checks
may be carried out with a credit reference agency and a fraud detection system, which will maintain a record of any such enquiry).
2. Shell may disclose data relating to the Retailer/Applicant to (1) a credit reference agency where it may be accessed by other financial
institutions to assist assessment of any application for credit made to Shell and for occasional debt tracing and fraud prevention;
(2) any agent or sub-contractor of Shell; (3) any supplier of the Retailer; (4) any person to whom Shell proposes to transfer any of its
rights and/or duties under the Agreement; (5) any guarantor or person providing security in relation to the Retailer’s obligations under
any agreement with Shell; (6) any third party to which the Retailer owes monies, or is alleged to owe monies, in connection with the
operation of the Business; (7) other companies in the Shell group of Companies in the Philippines; (8) other parties as may be notified to the Retailer by
Shell from time to time; (9) as otherwise required or permitted by law or any regulatory authority.
3. The Retailer and/or Applicant explicitly hereby consents to the use of their information for the purposes in these paragraphs.
Signed: ________________________________________ Date:_________________________________
4. Shell may use information about the Retailer and/or Applicant to send the Retailer and/or Applicant information about other goods
and/or services offered by Shell and/or by third parties (including companies in the Royal Dutch/Shell Group) which Shell believes
may be of interest to the Retailer and/or Applicant. Shell may also provide details of a Retailer or Applicant’s name, address and
other information as part of a mailing list to third parties (including companies in the Royal Dutch/Shell Group) to enable them to
market goods and/or services which Shell believes may be of interest to the Retailer/Applicant. Retailers and/or Applicants may be
contacted about other goods and services by any means (including telephone and e-mail).
Please tick this box if you do not wish to receive this information:
