WHAT IS THE PURPOSE OF THIS FORM

 

To assist a government department in selecting a person for an advertised post.

 

This form may be used to identify candidates to be interviewed. You need to fill in all sections of this form completely, accurately and legibly. This will help to process your application fairly.

 

WHO SHOULD COMPLETE THIS FORM

 

Only persons wishing to apply for an advertised position in a government department.

 

ADDITIONAL INFORMATION

 

This form requires basic information. Candidates who are selected for interviews will be requested to furnish additional certified information that may be required to make a final selection.

 

SPECIAL NOTES

 

 

  1.    – All information will be treated with the strictest confidentiality and will not be disclosed or used for any other purpose than to assess the suitability of a person, except in so far as it may be required and permitted by law. Your personal details must correspond with the details in your ID orpassport.

 

  1.    – Passport number in the case of non- SouthAfricans.

 

  1.   – This information is required to enable the department to comply with the Employment Equity Act,1998.

 

  1.   – This information will only be taken into account if it directly relates to the requirements of theposition.

 

  1.   The Executive Authority shall consider the criminal record (s) against the nature of the job functions in line with internal information security and disciplinarycode.

 

  1.    The applicant may submit additional information separately where the space provided is notsufficient.

 

  1.     Departments must accept certified documents that accompany the application(s) with certification that is up to 6 months, unless the advert prescribes a longerperiod.

 

A. THE ADVERTISED POST (All sections of this form are compulsory)

Position for which you are applying (as advertised)

Department where the position was advertised

Reference number (as stated in the advert)

If you are offered the position, when can you start OR how much notice must you serve with your currentemployer?

 

B. PERSONAL INFORMATION1

Surname and Full names

 

 

 

Date of Birth

 

DD/MM/YY

Identity Number

 

 

 

 

 

 

 

 

 

 

 

 

 

Passport2

number

 

 

 

 

 

 

 

 

 

 

 

 

 

Race3

African

White

Coloured

Indian

Other

Gender3

Female

Male

Do you have a disability?

Yes

No

Are you a South African citizen?

Yes

No

If no, what is your nationality?

 

Do you have a valid work permit? (only if non-South African)

Yes

No

Have you been convicted or found guilty of a criminal offence (including an admission of guilt)? 5

If yes (provide the details)

Yes

No

 

Do you have any pending criminal case against you? If yes, (provide the details)5

Yes

No

 

Have you ever been dismissed for misconduct from the Public Service?4

Yes

No

If yes (provide the details)6

 

Do you have any pending disciplinary case against you? If yes, (provide the details)

Yes

No

 

Have you resigned from a recent job pending any disciplinary proceeding against you? 4

If yes, (please note that the provisions of the Public Service Act shallapply).

Yes

No

 

Have you been discharged or retired from the Public Service

on grounds of Ill-health or on condition that your cannot be re- employed?4

Yes

No

Are you conducting business with the State or are you a Director of a Public or Private company conducting business with the State?6If yes, (provide the details)6

Yes

No

In the event that you are employed in the Public Service, will you immediately relinquish such business interests?

Yes

No

Please specify the total number of years of experience you have

Private

Sector

Public Sector

 

 

If your profession or occupation requires official registration, provide date and particulars of registration

Date

Reg. No

 

 

 


 

 

8- Each application for employment form must be duly signed and initialed by the applicant. Failure to sign this form may lead to disqualification of the application  during the selectionprocess.

 

C. CONTACT DETAILS AND MEDIUM OFCOMMUNICATIONS

Preferred language for correspondence

 

Method for

correspondence

Post

E-mail

Fax

Telephone

Contact details (in terms of the above)

 

 

D. SOUTH AFRICAN OFFICIAL LANGUAGE PROFICIENCY – state ‘good’, ‘fair’, or ‘poor’

 

Languages (specify)

 

 

 

 

 

Speak

 

 

 

 

 

Write or read

 

 

 

 

 

 

E. FORMAL QUALIFICATION7(from highest to the lowest)

Name of School/Technical College

Name of qualification obtained

Year obtained

 

 

 

 

 

 

 

 

 

 

 

 

Current study (institution and qualification):

 

F. WORK EXPERIENCE (Also attach a detailed CV)6

Employer (including current employer)

Post held

From

To

Reason for leaving

 

MM

 

YY

 

MM

 

YY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you were previously employed in the Public Service, is there any condition that prevents your re- appointment

Yes

No

If yes, Provide the name of the previous employing department and indicate the

nature of the condition.

 

 

G. REFERENCES

Name

Relationship to you

Tel. No. (office hours)

 

 

 

 

 

 

 

 

 

 

DECLARATION

I declare that all the information provided (including any attachments) is complete and correct to the best of my knowledge. I understand

that any false information provided will result in my application being disqualified or disciplinary action taken against me if I am appointed:

 

Signature:

 

Date: