A.
THE ADVERTISED POST
Position for which you are Department where the position
applying (as advertised) was advertised
WHAT IS THE PURPOSE OF
THIS FORM
To assist a government depart-
ment in selecting a person for
an advertised post. Reference number (as stated in If you are offered the position,
the advert) when can you start OR how much
This form may be used to iden- notice must you serve with your
tify candidates to be inter- current employer?
viewed. Since all applicants
cannot be interviewed, you
need to fill in this form com-
pletely, accurately and legibly.
This will help to process your
application fairly.
WHO SHOULD COMPLETE
THIS FORM
B. PERSONAL INFORMATION (please ignore if you have
Only persons wishing to apply attached a CV with ALL of the following information) 1
for an advertised position in a Surname
government department.
First names
ADDITIONAL INFORMATION Date of birth
This form requires basic infor- Identity number2
mation. Candidates who are
selected for interviews will be Race3 African White Coloured Indian
requested to furnish additional Gender 3
Female Male
certified information that may be
3
required to make a final Do you have a disability? Yes No
selection.
Are you a South African citizen? Yes No
SPECIAL NOTES If no, what is your nationality?
1 – All information will be treated And do you have a valid work permit? Yes No
with the strictest confidentiality Have you been convicted of a criminal Yes No
and will not be disclosed or used offence or been dismissed from employ-
for any other purpose than to ment?4
asses the suitability of a person,
except in so far as it may be
If your profession or occupation requires
required and permitted by law. State or official registration, provide date and
Your personal details must particulars of registration
correspond with the details in
your ID or passport.
2 – Passport number in the case
of non-South Africans. C. HOW DO WE CONTACT YOU
3 – This information is required Preferred language for correspondence?
to enable the department to
comply with the Employment Telephone number during office hours
Equity Act, 1998.
Preferred method for
Post E-mail Fax
4 – This information will only be correspondence
taken into account if it directly
relates to the requirements of
the position. Correspondence
contact details (in
5 – Applicants with substantial terms of above)
qualifications or work experience
must attach a CV.
D. LANGUAGE PROFICIENCY – state ‘good’, ‘fair’, or ‘poor’
Languages (specify)
Speak
Read
Write
E. QUALIFICATIONS5 (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 EXPERIENCE5 (please ignore if you have attached a CV with these details)
Employer (including Post held From To Reason for leaving
current employer)
MM YY MM YY
If you were previously employed in the Public Service, indicate whether any
Yes No
condition exists that prevents your re-appointment
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:
