B. PERSONAL INFORMATION
(please ignore if you have
attached a CV with ALL of the following information)
1
C. HOW DO WE CONTACT YOU
A. THE ADVERTISED POST
G.P.-S. 81/97143
Z 83 (81/971431)
REPUBLIC OF SOUTH AFRICA
WHAT IS THE PURPOSE OF
THIS FORM
To assist a government depart-
ment in selecting a person for
an advertised post.
This form may be used to iden-
tify candidates to be inter-
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
Only persons wishing to apply
for an advertised position in a
government department.
ADDITIONAL INFORMATION
This form requires basic infor-
mation. Candidates who are
selected for interviews will be
requested to furnish additional
certified information that may
be required to make a final
selection.
SPECIAL NOTES
1
All information will be
treated with the strictest confi-
dentiality and will not be dis-
closed or used for any other
purpose than to assess the
suitability of a person, except in
so far as it may be required and
permitted by law. Your personal
details must correspond with
the details in your ID or
passport.
2
Passport number in the
case of non-South Africans.
3
This information is required
to enable the department to
comply with the Employment
Equity Act, 1998.
4
This information will only be
taken into account if it directly
relates to the requirements of
the position.
5
Applicants with substantial
qualifications or work experi-
ence must attach a CV.
Position for which you are
applying (as advertised)
Department where the position
was advertised
Reference number (as stated in
the advert)
Surname
First names
Date of birth
Identity number
2
Race
3
African White Coloured Indian
Female Male
Yes No
Yes No
Yes No
Yes No
Gender
3
Do 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 criminal
offence or been dismissed from employ-
ment?
4
Preferred language for correspondence?
Telephone number during office hours ( )
Preferred method for
correspondence
Post E-mail Fax
Correspondence
contact details (in
terms of above)
If your profession or occupation requires
State or official registration, provide date
and particulars of registration
If you are offered the position,
when can you start OR how
much notice must you serve
with your current employer?
APPLICATION FOR EMPLOYMENT
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.
D. LANGUAGE PROFICIENCY—
state ‘good’, ‘fair’, or ‘poor
E. QUALIFICATIONS
5
(please ignore if you have attached a CV with these details)
F. WORK EXPERIENCE
5
(please ignore if you have attached a CV with these details)
G. REFERENCES
(please ignore if you have attached a CV with these details)
DECLARATION
Speak
Read
Write
Languages (specify)
Name of School/Technical College
Tertiary education (complete for each qualification you obtained)
Name of institution
Current 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 re-appointment.
Yes No
Name
Signature: Date:
Relationship to you Tel. No. (office hours)
If yes, provide the name of the previous employing department
Post held
MM YY MM YY
From To
Reason for leaving
Name of qualification Year obtained
Highest qualification obtained Year obtained
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