Application for Employment - Z83

1 B. PERSONAL INFORMATION (please ignore if you haveattached a CV with ALL of the following information)1C. HOW DO WE CONTACT YOUA. THE ADVERTISED 81/97143Z 83(81/971431)REPUBLIC OFSOUTHAFRICAWHAT IS THE PURPOSE OFTHIS FORMTo assist a government depart-ment in selecting a person foran advertised form may be used to iden-tify candidates to be inter-viewed. Since all applicantscannot be interviewed, youneed to fill in this form com-pletely, accurately and will help to process yourapplication SHOULD COMPLETETHIS FORMOnly persons wishing to applyfor an advertised position in agovernment INFORMATIONThis form requires basic infor-mation. Candidates who areselected for interviews will berequested to furnish additionalcertified information that maybe required to make a NOTES1 All information will be treated with the strictest confi-dentiality and will not be dis-closed or used for any otherpurpose than to assess thesuitability of a person, except inso far as it may be required andpermitted by law.

2 Your personaldetails mustcorrespond withthe details in your ID or Passport number in thecase of non-South This information is requiredto enable the department tocomply with the EmploymentEquity Act, This information will only betaken into account if it directlyrelates to the requirements ofthe Applicants with substantialqualifications or work experi-ence must attach a for which you areapplying (as advertised)Department where the positionwas advertisedReference number (as stated inthe advert)SurnameFirst namesDate of birthIdentity number2 Race3 AfricanWhiteColouredIndianFemaleMaleYesN oYesNoYesNoYesNoGender3Do you have a disability?3 Are you a South African citizen?If no, what is your nationality?And do you have a valid work permit?Have you been convicted of a criminaloffence or been dismissed from employ-ment?4 Preferred language for correspondence?Telephone number during office hours( ) Preferred method forcorrespondencePostE-mailFaxCorrespond encecontact details (interms of above)If your profession or occupation requiresState or official registration, provide dateand particulars of registrationIf you are offered the position,when can you start ORhowmuch notice must you servewith your current employer?

3 Application FOR Employment I declare that all the information provided (including any attachments) is complete and correctto the best of my knowledge. I understand that any false information supplied could lead to myapplication being disqualified or my discharge if I am LANGUAGE PROFICIENCY state good , fair , or poor E. QUALIFICATIONS5(please ignore if you have attached a CV with these details)F. WORK EXPERIENCE5(please ignore if you have attached a CV with these details)G. REFERENCES(please ignore if you have attached a CV with these details)DECLARATIONS peakReadWriteLanguages (specify)Name of School / Technical CollegeTertiary education (complete for each qualification you obtained)Name of institutionCurrent study (institution and qualification):Employer (including current employer)If you were previously employed in the Public Service, indicate whether any condi-tion exists that prevents your :Date:Relationship to youTel. No. (office hours)If yes, provide the name of the previous employing departmentPost heldMMYYMMYYFromToReason for leavingName of qualificationYear obtainedHighest qualification obtainedYear obtai