NOTE:

*.Mark the envelope “Vacancy” and address it to:

The Municipal Manager, P O Box 16, Rustenburg, 0300

2.Certified copies of Identity document, educational certificates, driver’s licence (if applicable), certificates of service and testimonials must be attached. (All the original certificates and documents shall be submitted by the successful applicant on commencement of service)

NO DOCUMENTS OR CERTIFICATES WILL BE RETURNED TO APPLICANTS

3.This form must be completed by the applicant personally.

SURNAME:

FULL NAMES:

RESIDENTIAL ADDRESS:

POSTAL CODE: TEL NO: CODE NO:

POSTAL ADDRESS:

POSTAL CODE: TEL NO: CODE: NO:

WORK ADDRESS:

POSTAL CODE: TEL NO: CODE: NO:

SPECIFY POSITION WHICH IS APPLIED FOR IN ACCORDANCE WITH ADVERTISED VACANCIES:

DIRECTORATE:

PLEASE COMPLETE PARTS A TO D AND MARK WITH A “X” WHEREVER APPLICABLE:

A. PERSONAL DETAILS (FOR RECORD PURPOSES ONLY)

1. Date of Birth: 2. Age

3. Are you a S.A. Citizen?

4. SEX AND MARITAL STATUS

4.1

4.2

5. DETAIL OF CHILDREN

5.1

5.2

6.Identity Number:

7. Are you in possession of a valid driver’s licence(s)?

If yes, specify code:

A CERTIFIED COPY OF YOUR DRIVER’S LICENCE/S MUST BE ATTACHED

8. Have you ever been dismissed from any employment?

8.1 State Particulars:

9.Details of condition of health and physical defects:

B. TRAINING AND QUALIFICATIONS

1.SCHOOL EDUCATION

1.1Highest standard passed: 1.2 Year passed

1.3 Name of school

1.4If you passed Gr 12, did you pass or

1.5 Subjects passed and symbols obtained (Please indicate subjects passed on higher grade

with (HG):

1.5.1

1.5.3

1.5.5

1.5.2

1.5.4

1.5.6

2. APPRENTICESHIP (QUALIFIED ARTISAN):

2.1 Are you a qualified artisan?

2.1 Type of Artisanship qualified for:

2.2Organisation / company where apprenticeship was completed:

2.3 Period of apprenticeship: From: to

3. POST SCHOOL EDUCATION

3.1 Name of educational institution 3.2 Certificates, Diplomas, Degrees 3.3 Date completed

3.1.1

3.1.2

3.1.3

3.2 Subjects: State eg. Economics 1, Psychology II: 3.3 Main subjects:

3.3.1

3.3.2

3.3.3

3.4Are you at present engaged in further study?

3.4.1 Name of educational institution:

3.4.2 Course

3.4.3 Date started

3.4.4 Subjects already completed:

3.4.5 Subjects at present engaged in:

4.APPLICABLE COURSES COMPLETED:

4.1 Name of course:

4.2Organisation where course was completed:

4.3Period of course:

Days Months

4.1.1

4.1.2

4.1.3

C. EXPERIENCE

1(a) Name of

Post held

From

To

Period

Employer

DD

MM

YY

DD

MM

YY

Y

M

1.1

1.2

1.3

1.4

1.5

1(b) Reasons for termination of service regarding the above-mentioned posts:

1.1

1.2

1.3

1.4

1.5

2. Details of current employer and occupation:

2.1Name of employer:

2.2Address of employer:

2.3Your present occupation title:

2.4 Salary and fringe benefits:

Your present basic salary per annum: R

Bonus R /a

2.5 Present incremental date:

Vehicle/Transport Allowance

Housing/Home Owners Allowance

Pension Fund

Provident Fund

Medical Fund

Vacation Leave days per year

Present period of notice:

3. Applicable duties at this stage:

4. Are you prepared to accept appointment on the commencing notch of the scale?

4.1If not, state notch R

D.IF YOU ARE NOT CONTACTED WITHIN TWELVE WEEKS AFTER THE CLOSING DATE FOR

APPLICATIONS, YOU MUST REGARD YOUR APPLICATION AS UNSUCCESSFUL, UNLESS AFTER

THAT PERIOD SPECIFICALLY INFORMED TO THE CONTRARY.

E. DECLARATION BY APPLICANT

1.I certify herewith that the above particulars are to the best of my knowledge true and correct.

2.I regard the completion of the application form as an offer to commence duty with the Rustenburg Local Municipality, subject to the Conditions of Employment and all applicable policies of the Rustenburg Local Municipality.

3.I waive all transport and subsistence payments if I should be appointed and not accept such appointment.

SIGNATURE OF APPLICANT DATE

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