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Z 83 (81/971431)REPUBLIC OF SOUTH AFRICA➧.-S. 81/97143 APPLICATION FOR EMPLOYMENTG.PA. THE ADVERTISED POSTPosition for which you are Department where the positionapplying (as advertised)was advertisedWHAT IS THE PURPOSE OFTHIS FORMTo assist a government depart-ment in selecting a person forReference number (as stated in If you are offered the position,an advertised post.the advert)when can you start OR howmuch notice must you serveThis form may be used to iden-with your current employer?tify candidates to be inter-viewed. Since all applicantscannot be interviewed, youneed to fill in this form com-pletely, accurately and legibly.This will help to process yourapplication fairly.B. PERSONAL INFORMATION (please ignore if you haveattached a CV with ALL of the following information) 1WHO SHOULD COMPLETETHIS FORMSurnameOnly persons wishing to applyfor an advertised position in aFirst namesgovernment department.Date of birthADDITIONAL INFORMATIONIdentity number2This form requires basic infor-mation. Candidates who areRace 3AfricanWhiteColouredIndianselected for interviews will berequested to furnish additionalGender 3FemaleMalecertified information that maybe required to make a finalDo you have a disability? 3YesNoselection.Are you a South African citizen?YesNoSPECIAL NOTESIf no, what is your nationality?1 – All information will be treated with the strictest confi-And do you have a valid work permit?YesNodentiality and will not be dis-closed or used for any otherHave you been convicted of a criminalYesNopurpose than to assess theoffence or been dismissed from employ-suitability of a person, except inment? 4so far as it may be required andpermitted by law. Your personalIf your profession or occupation requiresdetails must correspond withState or official registration, provide datethe details in your ID or and particulars of registrationpassport.2 – Passport number in thecase of non-South Africans.C. HOW DO WE CONTACT YOU3 – This information is requiredto enable the department toPreferred language for correspondence?comply with the EmploymentEquity Act, 1998.Telephone number during office hours( ) 4 – This information will only betaken into account if it directlyPreferred method forPostE-mailFaxrelates to the requirements ofcorrespondencethe position.5 – Applicants with substantialC o r r e s p o n d e n c equalifications or work experi-contact details (interms of above)ence must attach a CV.D. LANGUAGE PROFICIENCY—state ‘good’, ‘fair’, or ‘poor’Languages (specify)SpeakReadWriteE. QUALIFICATIONS 5 (please ignore if you have attached a CV with these details)Name of School / Technical CollegeHighest qualification obtainedYear obtainedTertiary education (complete for each qualification you obtained)Name of institutionName of qualificationYear obtainedCurrent study (institution and qualification):F. WORK EXPERIENCE 5 (please ignore if you have attached a CV with these details)FromToEmployer (including Post heldReason for leavingcurrent employer)MMYYMMYYIf you were previously employed in the Public Service, indicate whether any condi-YesNotion exists that prevents your re-appointment.If yes, provide the name of the previous employing departmentG. REFERENCES (please ignore if you have attached a CV with these details)NameRelationship to youTel. No. (office hours)DECLARATIONI 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 appointed.Signature:Date: