Chevron Application Form
Application for Employment
Please type or print your answers in black ink. Strictly Confidential
Position applied for Job Number
Surname First Name
Where did you see this position advertised/source
If you have come through a recruitment agency -
please state which agency?
Please state your current remuneration (basic
salary, allowances, bonus and other benefits)
** for urgent and confidential calls
Have you been employed by Chevron or any former or current affiliate? Yes/No
If yes, please give details of dates and in what capacity.
Have you applied previously to Chevron?
If yes, please give details of dates and in what capacity.
Do you require a UK Work Permit? Yes/No
* Please see note below
If yes, do you possess a valid UK
Please give details
Are you a Working Holidaymaker?
Please specify the dates that you
have worked in the UK.
If applicable to position applied for,
please could you confirm whether you
possess a full UK Driving Licence. Yes/No
If licence endorsed, please give details
Date of Availability
Please advise the period of notice you are required to give your present employer.
Please give below the names and addresses of two people to whom we may apply for information
about your work. At least one should be your immediate manager in your current, or most recently
held, position. No approach will be made to your current employer until we have your verbal
permission to do so.
Please note, if you are leaving full time education, please give details of an
individual we can approach for an academic reference.
Please give details of any previous criminal convictions or pending court appearances relating to a
criminal act. (You are not required to divulge details of “spent” convictions as defined by the
Rehabilitation of Offenders Act 1974).
Note: If you are invited to attend an interview, please bring with you: i) Your original degree and higher education
certificates (if applicable), ii) Documentary evidence of your entitlement to work in the UK. This could include a birth
certificate issued in the UK or Republic of Ireland; a passport describing the holder as a Britain citizen; a EU passport, or
a letter issued by the Home Office confirming the right to work
The information I have provided on this form is correct to the best of my knowledge. I understand
that if I provide false information or withhold relevant information, my application is liable to be
rejected or, if I am appointed my contract of employment will be liable to termination.
Signed __________________________________________ Date ________________________
Please attach a copy of your current CV/Résumé
Please read the list of definitions
before answering the questions overleaf
The Disability Discrimination Act 1995 defines a disabled person as “someone with a physical or mental
impairment that has a substantial and long-term adverse effect on his ability to carry out normal day-to-day
The following is a list of some medical definitions or impairments that might cause someone to describe
themselves as “having a disability”. It is not meant to be an exclusive list and is given for guidance only.
(Information provided courtesy of the Employers’ Forum on Disability).
Visual: Examples: registered blind or partially sighted
(If you wear corrective lenses, this is not normally considered a disability)
Co-ordination, Examples: polio, spinal cord injury, severe back problems, difficulty with fine
dexterity, mobility: motor skills, amputation, need for a cane, crutches, braces, wheelchair, prosthesis or
other assistive medical devices.
Mental health: Examples: schizophrenia, depression, severe phobias, severe stress.
Speech: Examples: difficulty in speaking, speech impairment, difficulty being understood,
communicates without speech.
Learning difficulties: Examples: Down’s syndrome, dyslexia, reading, or writing difficulty.
Hearing: Examples: Deaf, hard of hearing.
Other physical or Examples: diabetes, epilepsy, arthritis, cardiovascular conditions, haemophilia,
medical conditions: asthma, cancer, facial disfigurement.
Ethnic origin questions are not about nationality, place of birth or citizenship. They are about colour and broad
ethnic group. UK citizens may belong to any of the groups listed below.
The categories provided are those used during the 1991 Census and are compatible with those recommended by
the Commission for Racial Equality (CRE). The classification is largely based on self-definition.
10 broad groups:
Full Listing from ethnic group
Black Caribbean: Black Caribbean
Black African: Black African
Africa South of the Sahara
Black Other: Other
Asian Other: E. African Asian
Other: North African/Arab/Iranian
Diversity and Equal Opportunities Monitoring Form
Chevron is committed to providing equality of opportunity and aims to ensure that no job applicant
receives less favourable treatment on the grounds of sex, marital status, race colour, nationality, ethnic or national
origins, religious grounds or disability. In addition, no job applicant should be disadvantaged by conditions or
requirements that cannot be shown to be justified and relevant to the job.
To enable us to ensure the effectiveness of our policy, we need to monitor our recruitment and selection practices.
The information you provide on this monitoring form will be used for statistical purposes only and will be treated
in the strictest confidence.
Chevron will store and/or process the data you provide on this monitoring form.
Prior to the start of the selection process, the Human Resources Department will detach this monitoring form from
your application. In the event you are subsequently employed by ChevronTexaco, the information provided on this
monitoring form will be transferred to your personal records and processed accordingly.
Position applied for
Any previous surname
Date of birth
Please indicate marital status
Male / Female
Divorced / Married / Single / Widowed
Do you consider yourself to have a disability?
(Please read the details on the reverse of this form before
* Where you have indicated that your consider yourself
to have a disability, please advise whether there are any
reasonable adjustments we would need to make to assist
you if you are selected for interview.
(Please note that
these adjustments will be discussed with the recruiting
manager prior to the interview).
Please indicate your ethnic origin by circling the appropriate code, for example ©. Please read the details on the
reverse of this form before indicating your ethnic origin.
b Black Caribbean
c Black African
d Black Other
i Asian Other
Yes / No *