Transcription of APPLICATION FORM: INTERNSHIP 2017/18
1 APPLICATION form : INTERNSHIP 2017 /18 PART 1: PERSONAL DETAILS Surname: Names: ID Number: Race: Nationality: Gender: Disability: Nature of Disability: _____ PART 2: CONTACT DETAILS Contact Numbers: Postal Address: Residential Address Email Address: PART 3: EDUCATION DETAILS Name of institution Degree/Diploma Major subjects Year obtained PART 4: CAREER FIELD ( Statistician, Demography, IT, HRM, etc.) AND preferred LOCATION for placement, please indicate your first and second preferred location (as advertised).
2 CAREER FIELD REFERENCE NO: LOCATION Head Office (Tick) Province (Tick) Name: PART 5: CRIMINAL RECORD AND EMPLOYMENT HISTORY Do you have a criminal record:?: Charge:_____ Have you ever participated in an INTERNSHIP in the Public Service?: Are you currently employed? Nature of Employment: _____ PART 6: DECLARATION: I declare that the information above is true and that the following documents have been attached: (Please tick each block if you have attached the documents required) CV Certified copies of ID and academic qualification(s) Certified copy of Grade 12 Certificate Certified copies of academic transcripts Signature of applicant: _____Date: _____ Cell: Alternative: Yes No Yes No Yes No Yes No
