Learnership Public Service

Application for Employment

A. THE ADVERTISED POST

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

current employer?

B. PERSONAL INFORMATION

Surname

First Names

Date of Birth

ID number

2

Race

3

African White Coloured Indian

Gender

3

FEMALE MALE

Do you have a disability?

3

YES NO

Are you a South African Citizen? YES NO

If no, what is your

Nationality

And do you have a valid work

Permit? YES NO

Have you ever been convicted of a

criminal offence or been dismissed

form employment?

4

YES NO

If your profession or occupation

requires State or official

registration, provide date and

particulars of registration.

C. HOW DO WE CONTACT YOU

Preferred language for correspondence?

Telephone number during office hours Preferred method for

correspondence

Post E-mail Fax

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.

Since all applicants cannot be

interviewed, you need to fill in 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 or passport.

2 – Passport number in the case of

non-South Africans.

3 – This information is required to

enable the department to comply

with the Employment Equity Act,

1998.

4 – This information will only be

taken into account if it directly

relates to the requirements of the

position.

5 – Applicants with substantial

qualifications or work experience

must attach a CV.

Correspondence contact

details (in terms of above)

D. LANGUAGE PROFICIENCY – state ‘good’, ‘fair’ or ‘poor’ Languages (specified)

Speak

Read

Write

E. QUALIFICATIONS

5

(please ignore if you have attached a CV with these details Name of School / Technical College Highest qualification obtained Year Obtained

Tertiary education (complete for each qualification you obtained) Name of Institution Name of Qualification

Year

Obtained

Current study (institution and qualification)

F. WORK EXPERIENCE

5

(please ignore if you have attached a CV with these details) Employer (including From To

current employer) Post held

MM YY MM YY

Reason for

Leaving

If you were previously employed in the Public Service, indicate whether any condition exists that prevents your re-employment YES NO If yes, provide the name of the previous employing department

G. REFERENCES (please ignore if you have attached a CV with these details) 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 supplied could lead to my application being disqualified or my discharge if I am appointed. Signature: Date:

Contact this candidate