Z 83 (81/971431)

G.P.-S. 81/97143
R EPUBLIC OF S OUTH A FRICA

APPLICATION FOR EMPLOYMENT

➧ A. THE ADVERTISED POST
Position for which you are Department where the position
applying (as advertised) was advertised

WHAT IS THE PURPOSE OF

SENIOR ANALYST: FUNDING DEPARTMENT OF PUBLIC
THIS FORM AND FINANCIAL ANALYSIS ENTERPRISES
To assist a government depart-
ment in selecting a person for Reference number (as stated in If you are offered the position,
an advertised post. the advert) when can you start OR how
much notice must you serve
This form may be used to iden- with your current employer?
tify candidates to be inter-
viewed. Since all applicants REF NO: DPE/2020/006 4 WEEKS
cannot be interviewed, you
need to fill in this form com-
pletely, accurately and legibly.
This will help to process your
application fairly. B. PERSONAL INFORMATION (please ignore if you have
WHO SHOULD COMPLETE attached a CV with ALL of the following information) 1
THIS FORM
Surname Rikhotso
Only persons wishing to apply
for an advertised position in a First names Nicolas Jack
government department.
Date of birth 19 January 1985
ADDITIONAL INFORMATION
Identity number 2 850119 5671 085
This form requires basic infor-
mation. Candidates who are
selected for interviews will be
Race 3 X
African White Coloured Indian

requested to furnish additional

certified information that may
Gender 3 Female XMale
be required to make a final
selection.
Do you have a disability? 3 Yes X No
SPECIAL NOTES
Are you a South African citizen? X Yes No

If no, what is your nationality?

1 – All information will be
treated with the strictest confi-
dentiality and will not be dis-
And do you have a valid work permit? X Yes No
closed or used for any other
purpose than to assess the
Have you been convicted of a criminal
offence or been dismissed from employ-
Yes
X No
suitability of a person, except in ment? 4
so far as it may be required and
permitted by law. Your personal
details must correspond with If your profession or occupation requires N/A
the details in your ID or State or official registration, provide date
passport.
and particulars of registration
2 – Passport number in the
case of non-South Africans.
3 – This information is required C. HOW DO WE CONTACT YOU
to enable the department to
comply with the Employment Preferred language for correspondence? English
Equity Act, 1998.
Telephone number during office hours ( 072 )
4 – This information will only be
taken into account if it directly Preferred method for
relates to the requirements of correspondence
Post X E-mail Fax
the position.
5 – Applicants with substantial C o r r e s p o n d e n c e nicolasrikhotso91@gmail.com
qualifications or work experi- contact details (in
ence must attach a CV. terms of above)
D. LANGUAGE PROFICIENCY—state ‘good’, ‘fair’, or ‘poor’
Languages (specify)
Xitsonga English Sepedi
Speak good good fair
Read good good fiar
Write good good fair

E. QUALIFICATIONS 5 (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 EXPERIENCE 5 (please ignore if you have attached a CV with these details)

Employer (including From To

Post held Reason for leaving
current employer)
MM YY MM YY

If you were previously employed in the Public Service, indicate whether any condi- Yes No
tion 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: