*

Application for Employment

Applicant Information

Full Name: Date:

First Last

Address:

Street Address Apartment/Unit #

City Province Code

Phone: Email:

Date Available: Desired Salary: R

Position Applied for

and area:

Are you a citizen of South Africa?

YES

NO

If not, are you authorized to work in the S.A.?

YES

NO

Have you ever been convicted of a felony?

YES

NO

If yes, explain:

Do you smoke?

YES

NO

Do you have your own transport?

YES

NO

Are you willing to relocate, if needed?

YES

NO

2

Education

High School: Address:

From: To: Did you graduate?

YES

NO

Tertiary: Address:

From: To: Did you graduate?

YES

NO

Degree /

diploma:

Other: Address:

From: To: Did you graduate?

YES

NO

Degree /

Diploma:

References

Please list professional references.

Full Name: Relationship:

Company: Phone:

Address:

Full Name: Relationship:

Company: Phone:

Address:

3

Full Name: Relationship:

Company: Phone:

Address:

Full Name: Relationship:

Company: Phone:

Address:

Full Name: Relationship:

Company: Phone:

Address:

Full Name: Relationship:

Company: Phone:

Address:

4

Previous Employment

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary: R Ending Salary: R

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference? YES

NO

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary: R Ending Salary: R

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference? YES

NO

5

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary: R Ending Salary: R

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference? YES

NO

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary: R Ending Salary: R

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference? YES

NO

6

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature: Date:

PLEASE ATTACH THE FOLLOWING:

1. A cover letter

2. Your CV

3. Your photo

4. Reference letters

5. Proof of education (certificates)

Please fax all the above to the following dedicated application fax line: 086*******

Contact this candidate