Z83 (81/971431)
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Initial……….
WHAT IS THE PURPOSE OF THIS FORM
To assist a government department in
selecting a person for an advertised post.
This form may be used to identify candidates
to be interviewed. You need to fill in all
sections of this form completely, 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 b
asic information.
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 confidentiali
ty and will not be
disclosed 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- The Executive Authority shall consider the
criminal record (s) against the nature of the
job functions in line with internal information
security and disciplinary code.
6- The applicant may submit additional
information separately where the space
provided is not sufficient.
7- Departments must accept certified
documents th
application(s) with certification that is up
to 6 months, unless the advert prescribes
a longer period.
A. THE ADVERTISED POST (All sections of this form are compulsory)
Position for which you are applying (as
advertised)
Department where the position was advertised
Reference number (as stated in the advert)
If you are offered the position, when can you
start OR how much notice must you serve
with your current employer?
B. PERSONAL INFORMATION
1
Surname and Full names
Date of
Birth
DD/MM/YY
Race
3
African White Coloured Indian Other
Gender
3
Female Male
Do you have a disability? Yes No
Are you a South African citizen? Yes No
If no, what is your nationality?
Do you have a valid work permit? (only if non-South African) Yes No
Have you been convicted or found guilty of a criminal offence
(including an admission of guilt)?
5
If yes (provide the details)
Do you have any pending criminal case against you?
If yes, (provide the details)
5
Have you ever been dismissed for misconduct from the Public
Service?
4
If yes (provide the details)
6
Do you have any pending disciplinary case against you?
If yes, (provide the details)
Have you resigned from a recent job pending any disciplinary
proceeding against you?
4
If yes, (please note that the provisions of the Public Service
Act shall apply).
Have you been discharged or retired from the Public Service
on grounds of Ill-health or on condition that your cannot be re-
4
Are you conducting business with the State or are you a
Director of a Public or Private company conducting business
with the State?
6
If yes, (provide the details)
6
In the event that you are employed in the Public Service, will
you immediately relinquish such business interests?
Please specify the total number of years of experience you
have
If your profession or occupation requires official registration,
provide date and particulars of registration
Republic of South Africa
APPLICATION FOR EMPLOYMENT
Effective 01 January 2021
