FOR OFFICE USE ONLY DATE REG NUMBER

FRONT OFFICE START TIME END TIME

BOOKED BY INTERVIEWED BY

- CONFIDENTIAL -
Please complete this application form as detailed as possible - The information requested on this application form is not for any discriminatory purposes and will be
used for our database and recruitment application, furthermore this application form does not constitute an offer of employment.

PERSONAL DETAILS
FIRST NAME MIDDLE NAMES

SURNAME KNOWN AS

TITLE mr, mrs, ms etc. GENDER

APARTMENT / COMPLEX NAME & NUMBER P.O. Box / PRIVATE BAG

STREET NAME & NUMBER SUBURB

RESIDENTIAL SUBURB POSTAL ADDRESS PROVINCE

ADDRESS
CITY CITY

CODE CODE

ID NUMBER DATE OF BIRTH

EE - For the purpose of employment equity
NATIONALITY
CLASSIFICATION provisions -

PERM WORK
RESIDENCY? PERMIT
if yes, since date? if yes, expiry date?

CELL NUMBER E-MAIL

TEL (HOME) TEL (WORK)

Name & Surname Relationship Contact Numbers
OTHER
CONTACTS

provide 3 – not
work contacts

LANGUAGES Home language: Other languages:

MARITAL STATUS MAIDEN NAME

DEPENDENTS
- gender & ages -

STATE OF HEALTH SMOKER

DRIVERS LICENSE TRANSPORT

own car, public, lift club
if yes, specify
CRIMINAL OFFENCES RELIGION

OUTSIDE INTERESTS
sports, hobbies, social activities

if yes specify
HAVE YOU EVER BEEN
DISABILITY?
SEQUESTRATED?
WHEN ARE YOU AVAILABLE NOTICE
FOR A NEW POSITION? PERIOD
WHERE DID YOU HEAR ABOUT
US?
 - Page 2 -

SECONDARY EDUCATION
Highest Standard Passed

High school attended Year

Subject Grade Symbol Subject Grade Symbol

1. 5.
2. 6.
3. 7.
4. 8.

TERTIARY EDUCATION
Name of Institution
Period at Institution From: To: Qualification Status

Qualification
Major subjects passed

Achievements/ Activities
Name of Institution
Period at Institution From: To: Qualification Status

Qualification
Major subjects passed

Achievements/ Activities
Name of Institution
Period at Institution From: To: Qualification Status

Qualification
Major subjects passed

Achievements/ Activities

COURSES ATTENDED
Course Institution Date

COMPUTER LITERACY - SOFTWARE YOU ARE FAMILIAR WITH

INDUSTRY METHODOLOGIES

GENERAL ACHIEVEMENTS
 - Page 3 -
CAREER RECORDS
Start with your present position and work backwards through your careerNB!Write out your
duties as detailed as possible. Do not copy from your CV. Elaborate on it!
NAME OF FIRM

TYPE OF INDUSTRY TEL NO

ADDRESS OF FIRM

POSITION SALARY

EMPLOYMENT DURATION
From: (month &year) To: (month & year)
REASONS FOR LEAVING

POSITION TYPE

DUTIES (detailed) 

ACHIEVEMENTS IN ROLE:

NAME OF FIRM

TYPE OF INDUSTRY TEL NO

ADDRESS OF FIRM

POSITION SALARY

EMPLOYMENT DURATION
From: (month &year) To: (month & year)
REASONS FOR LEAVING

POSITION TYPE

DUTIES (detailed) 

ACHIEVEMENTS IN ROLE:
 - Page 4 -
CAREER RECORDS (CONTINUED)
NB! Duties as detailed as possible
NAME OF FIRM

TYPE OF INDUSTRY TEL NO

ADDRESS OF FIRM

POSITION SALARY

EMPLOYMENT DURATION
From: (month &year) To: (month & year)
REASONS FOR LEAVING

POSITION TYPE (indicate with a tick)

DUTIES (detailed) 

ACHIEVEMENTS IN
ROLE:

NAME OF FIRM

TYPE OF INDUSTRY TEL NO

ADDRESS OF FIRM

POSITION SALARY
EMPLOYMENT DURATION
From: (month &year) To: (month & year)
REASONS FOR LEAVING

POSITION TYPE (indicate with a tick)

DUTIES (detailed) 

ACHIEVEMENTS IN
ROLE:
 - Page 5 -
CAREER RECORDS (CONTINUED)
NB! Duties as detailed as possible
NAME OF FIRM

TYPE OF INDUSTRY TEL NO

ADDRESS OF FIRM

POSITION SALARY

EMPLOYMENT DURATION
From: (month &year) To: (month & year)
REASONS FOR LEAVING

POSITION TYPE (indicate with a tick)

DUTIES (detailed) 

ACHIEVEMENTS IN ROLE:

NAME OF FIRM

TYPE OF INDUSTRY TEL NO

ADDRESS OF FIRM

POSITION SALARY
EMPLOYMENT DURATION
From: (month &year) To: (month & year)
REASONS FOR LEAVING

POSITION TYPE (indicate with a tick)

DUTIES (detailed) 

ACHIEVEMENTS IN ROLE:
 - Page 6 -
WORK REFERENCES
based in South Africa and who may be contacted now

NAME OF FIRM BRANCH

POSITION HELD BY YOU

CONTACT PERSON DESIGNATION

CONTACT NUMBERS

NAME OF FIRM BRANCH

POSITION HELD BY YOU

CONTACT PERSON DESIGNATION

CONTACT NUMBERS

NAME OF FIRM BRANCH

POSITION HELD BY YOU

CONTACT PERSON DESIGNATION

CONTACT NUMBERS

For practical purposes, APMC will only establish contact with you in the event of concrete feedback from the Client. AP
Management Consultant (Pty) Ltd (APMC) respects your right to confidentiality and privacy and takes the protection of your
personal information very seriously. APMC has implemented measures, procedures and policies to ensure all of your personal
information, which is collected, processed, stored and shared with staff and Clients, is protected in all aspects as well as in line with
the POPI Act.

You have the right to refuse to complete the application form, refuse to supply any information and documentation, refuse to
complete assessments presented to you and/or fail to send outstanding documentation needed as part of the application process
but acknowledge that your refusal or non-compliance will result in your application being marked as incomplete and APMC will not
be able to complete the recruitment and application process.

By signing this application form and furnishing all the supplied information, you understand, agree, acknowledge, and consent to
APMC collecting, processing, storing and sharing your Personal and Special Personal Information, and that this will be been done
with your permission, voluntarily and on your own accord, including and not limited to all of the information provided to APMC during
this application process, the application form, your personal contacts, your profile photo for our database and your CV, an online
registration, CVs submitted via fax or email, information from online career portals, information collected in the interview, responses
to job advertisements, personal records, career records, education certificates and transcripts, performance records, reference
letters, payslips, work references, social media profiles and/or publicly accessible records, letters, documentary evidence, emails,
certified documents, assessments and any other information which you have submitted that will assist in your Recruitment
Application.

The aforementioned supplied information includes all information requested on this application form, including, but not limited to
employment equity status, race, gender, marital status, nationality, age, disability, identity number, languages, education and
qualifications, training, skills, contact information, employment status, employment history, etc. Furthermore all Special Personal
Information which includes, but is not limited to religion, philosophical beliefs, race, ethnic origin, health, criminal behaviour, etc.

The personal information that you have supplied to APMC, and has been collected, will be captured, processed, stored and shared,
specifically for the purpose of a detailed and comprehensive recruitment and selection process which you have chosen to
participate in. The recruitment and selection process comprises of a comprehensive range of activities that APMC uses to identify
the required skills as stipulated by Client recruitment needs. This includes the initial obtainment of Personal Information, Special
Personal Information as well as the retention, use, access and searchability of your information on a secure database, and
disclosure and final disposal of this information and data.

Recruitment activities that will constitute processing, or further processing, include: 1. The recruitment and selection process
commencing with the advertising of vacancies, receiving, sorting and storing of applications, the short listing process, interviews,
vetting and verifying of data provided by you, communications to successful and unsuccessful applicants, searching for suitable
candidates on a secure database to match up with Client positions and letters of appointment, submitting CVs on your behalf,
securing interviews with Clients, facilitating Client feedback and facilitate successful placement; 2. Processing payment of
remuneration, recording bank account details, payslips and tax records; 3. Receiving and storing of leave applications and records,
sick leave and medical records, records and communications relating to injuries on duty and otherwise; 4. Monitoring performance,
conducting written performance assessments, dealing with promotions and demotions and the records of disciplinary processes; 5.
Obtaining, distributing and storing information relating to medical aid membership, medical aid claims, payment of medical aid
subscriptions, membership of retirement funds, contributions to retirement funds and their administrators and retirement benefits; 6.
Obtaining, creating and storing of information relating to termination of employment, the issue of references and exit interviews; The
exchange of information of staff members in a business transfer or out sourcing transaction.
 - Page 7 -
You consent to APMC processing and capturing your Personal Information and information contained in the attachments submitted
with this application form and listed above on our secure database, to continuously create a professional, bespoke career resume
which will be made available to our Clients in line with Client job or project specifications.

You agree that APMC has the right to decline your application, for any reasons whatsoever, based on comprehensive selection
criteria, outcomes of your interview, as well as compliance with Client minimum requirements and skills needed to fulfil position
requirements. In the event that you are shortlisted for a Client vacancy, you agree that APMC can forward your personal details to
the Client and act on your behalf, and that the Client will further process your information for the purpose of the recruitment process.

In the event that you either match or do not match a Client's minimum requirements for a possible role and your application for the
specific role be unsuccessful, you agree that APMC will continue to capture, process and retain your information (including any
information submitted during your application) for an unlimited period on their secure database and on file, with staff access to
ensure your information will be included in all future searches relevant to your profession to continue to give you access to current
and future career opportunities which may arise

APMC has strict policies which ensure that your information will only be released to Clients with your consent, except where we are
required to do so by law, in the latter case we will inform you before doing so.

You declare that all the information provided in this application form and all the supporting documentation pertaining to your
personal information, career, training and education, etc. is complete, correct and truthful and ensure that no information has been
omitted.

APMC will investigate with previous employers including Supervisors, colleagues and Human Resources to conduct in-depth
references so as to verify all of the information you have provided, which includes Referees and contacts you have supplied to us or
not. References remain confidential to APMC and will only be disclosed if consent is given by the Referee. Furthermore, you
authorise all of your former employers, colleagues and HR to furnish information pertaining to your current and past employment,
with your reasons for leaving, your performance and any other information, whether formally on record or not, for the purpose of the
recruitment process.

Should any information furnished herein be false or incorrect, omitted or non-disclosed on your part, you hereby do not hold APMC
and/or your previous employers accountable and release all parties from liability against any action taken whatsoever, in the event
that any contradictory information arises, from any source, which may lead to you not obtaining the position for which you have
applied. Such omission or false statements may cause extensive harm to APMC and APMC has the right to take legal action
against you.

You authorise APMC to submit and forward any information, whether claimed or not, that you have provided (both telephonically
and in writing) to third parties that provide information verification services, including but not limited to TransUnion, MiE, the South
African Police Service, the South African Government and any other educational, training, credit assessment and fraud prevention
and related organisations, for the purpose of acquiring your current contact details should you no longer be contactable via contact
details or personal contacts supplied to APMC and to verify your personal credentials and records including but not limited to
education, qualification, membership, employment, credit, criminal record, license, fraud prevention, drug detection and other
verifications. This is solely for the purpose of proposed employment and/or continuation of employment. You unconditionally
indemnify APMC and its suppliers against any liability that may result from furnishing information in this regard. If APMC is unable
to contact you on contact details provided at application stage, you authorise APMC to contact your personal contacts supplied on
application form to establish contact with you.

You acknowledge APMC’s intention of performing a credit check and confirm that you consent to APMC in terms of the National
Credit Act, no. 34 of 2005, to conduct a Credit Check on you with the relevant body and to further disclose such information to
Clients that, in terms of this application, require the information for recruitment and application purposes.

APMC may perform a variety of assessments to determine your suitability for a position and compliance with minimum
requirements specified by Clients and job specifications to assess skill levels, experience and competencies. You hereby consent to
any aforementioned assessments and for your results to be forwarded to third parties. Furthermore, you understand why
assessments are necessary and how results will be used, and that these assessments are appropriate and valid.

APMC will protect your information to the best of their ability, in line with industry standard practices, on a state of the art database
which is both digitally and physically secured and which can only be accessed by authorised APMC personnel. Aforementioned
personnel are kept up to date on security and privacy best practices and APMC’s server is kept in a strictly access controlled
environment. You agree that in the unfortunate event that APMC is made aware of your death APMC will retain your basic
information on file and database. You have the right to remove your personal details from APMC’s database, but agree to the fact
that APMC will only retain basic information in order to keep track of candidates who have requested the removal of their details, in
order to avoid future duplication.

By signing this application form you understand, accept and consent to the above.

SIGNED ON THIS ____________DAY OF ___________________________20_______ IN ____________________________________

_____________________________________________ ___________________________________________________
APPLICANT’S SIGNATURE INTERVIEWER’S SIGNATURE

FOR OFFICE USE ONLY v.1.6 – app form