DEPARTMENT OF LABOUR - ESSA

1 DdmmyyyddmmyyyyAA1 BCC1DD1EB ECEDMWd dmmy yYNYN ddmmyyGrade 6 / Std 4 EDUCATION AND TRAINING - FURTHER AND HIGHER EDUCATION AND TRAININGD isability BlindnessChronic ConditionsDeafnessSpeech ImpairedNone7826 ABET Level Abet Level 4 = Grade 8 - 9 Abet Level 1 = Grade 1 - 3 Abet Level 2 = Grade 4 - 5 Abet Level 3 = Grade 6 - 7 Subject School subjectsSymbol or %534 EDUCATION AND TRAINING - SCHOOL SUBJECTS1 Indicate the different school subjects that you have completed at school. (Spave provided for only 8 subjects)Name of School * Year Obtained * Grade 8 / Std 6 Grade 9 / Std 7 Grade 10 / Std 8 / NTC 1 Grade 3 / Std 1 Grade 4 / Std 2 HGGrade 11 / Std 9 / NTC 2 LGSGLGO pportunity interest Willing to relocate (If yes please specifify the Province/s)Expected monthly salary rangeHGGrade 5 / Std 3 SCHOOL INFORMATIONG rade 0 Grade 1 CONTACT DETAILS - STREET ADDRESSREGISTER AN INDIVIDUALDEPARTMENT OF LABOUR - ESSAI dentity Number (13 Digits) *ESSA ACCESS INFORMATIONDate of BirthAll fields indicated / highlighted in grey is COMPULSORY fields.

2 These fields must be completed in full. A correctly completed form will assist an official at this DEPARTMENT to find a suitable opportunity for you. PLEASE COMPLETE THE FORM IN BLOCK LETTERS. ReadPostal Address Line 1 LanguageSpeakCONTACT DETAILS - POSTAL ADDRESS2001 - 4000 ProjectNorth WestIndividual in a projectYes12001 - 15000 Northern CapeIf YES, Please specify the Towns within the Province1 MarriedInternshipNoYesGautengLearnership YesMake my CV details available to other organisations No8001 - 12000 Accept Terms If Offender: Parole/Release DateFemaleNoYesID Document Presented and Verified ? DivorcedName and Surname of DoL OfficialSingleLife PartnerPlease indicate your lanuage proficiency, Excellent (E), Good (G) or Average (A) (Space has only been provided for 5 options) AND TRAINING - GENERAL EDUCATION AND TRAINING LEVELA lternative contact person's nameTelephone number (Alternative person's)Email address (Alternative person's)

3 Street Address Line 1 ED1 CONTACT DETAILS - PERSONAL CONTACTC ellular Number Drivers License Code/Classification FaxPreferred contact methodTelephonePostE-mailPostal Code City/Town Suburb Grade 7 / Std 5 GradeHGHGG rade 12 / Std 10 / NTC 3 OGSGSGLGOGOGHGSGLGOGHGHGOGLGOGSGLGOGR ehabilitatedApprenticeshipFormal JobIndividual seeking infoOtherPlaced by ESSA6001 - 8000 MaleHard of hearingPhysical disabilityPartially SightedNot applicableColouredAfricanIndianGender Marital Status Fax numberDrivers License Expiry DatePublic Drivers PermitExpire DateSMSHome Telephone Email addressStreet Address Line 2 NoneOffenderProvinceCriminal Status Kwazulu NatalMphumalanga15001 - 20000 LanguageHighest Schooling Level 0-12 Completed * Postal Code City/Town ProvincePermit DescriptionSuburb Grade 2 Equity Group WhiteWidowerWidowFree State23 HGSGLGSGP ostal Address Line 2 EC1 Unemployed workseekerOGSGLGH azardous Substances Permit> 20 000 Western Cape Limpopo< 20004001 - 6000 YesNoNot applicable / UnspecifiedForeign / Non South AfricanEastern CapeNoIndividual Type Do you have access to OWN transport?

4 Employed WorkseekerSurname Visually ImpairedMental / Neurological ConditionsPERSONAL DETAILS - PERSONALF irst Names Higher Tertiary QualificationsJob Hunting SkillsFinancing your studiesLearnershipProjectsMaking a career decision - GuidanceStudy SkillsSmall Business DevelopmentApprencticeshipUmsombomvu Youth InternshipsInstitutionsNote on NQF Levels: 5 = National Diploma/Occupational Certificate, 6 = Bachelors / First degree, 7 = Professional qualification / honours degree, 8 = Post-doctoral research degrees / doctorates / Masters degree. Note on Status: In progress or Complete or UNIT STANDARDSU nitsName of Unit StandardUnit 1 NQF LevelInstitution Qualification 4 Qualification 3 Qualification Name (Example: BA degree)SERVICES REQUIRED FROM THE DEPARTMENT OF LABOUR - Please TICK the box where you would like to obtain more information Title Reference 3 Reference 4 Reference 1 Reference 2 NQF Level Unit 2 Unit 3 Membership / Registration NumberCourse YearYear CompletedNo.

5 Of CreditsDate From Date To Status Skills Name of skills ( = Driving Skills)Skills LevelSKILLS AND EXPERIENCEEMPLOYMENT HISTORY - PROFESSIONAL AFFILIATIONSO rganisation/Company Note on Skills Level = Only training or Limited Practical or Thorough Practical or Extensive Practical Skill 2 Employed From Day - Month - YearDuties perform within job:Skill 1 Employed To EMPLOYMENT HISTORY - HISTORY 1 Day - Month - YearProfessional AffiliationsF = Medical condition - Maternity A = DismissalB = ResignedJob Title Career objectivesPrizes and awards Noteworthy Experience & MilestonesReference 5 Contact Number K = Expired employment contract G = Employer Closed business Body (For example HPCSA)H = Voluntary = Temporary Reasons for leavingStatus/Rank E = Medical condition - General OTHER SHORT COURSESQ ualification 1 Qualification 2 Year CoursesType Of Employment Company Name Course 2 Course 1 Course 4 Course 3 Note on.

6 TYPE OF EMPLOYMENT D = OtherL = OtherCourse Name (For example: PC Course)Institution (For example: ABC Training Centre)Name of skills B = Fixed ContractA =PermanentNote on Reasons for leaving: C = PromotionD = Retrenched J =Pension retirement I = TransferredSkills LevelDuties perform within job:Duties perform within job:Duties perform within job.