Application for Employment

WHAT IS THE PURPOSE OF THIS A. THE ADVERTISED POST

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.
Since all applicants cannot be
interviewed, you need to fill in this
form completely, accurately and
legibly. This will help to process
your application fairly.
Position for which you are applying Department where the position was
(as advertised) advertised
Administrative clerk : Departmenent of higher
Examination education.
Reference number (as stated in the If you are offered the position,
advert) when can you start OR how much
SUP/RFT/AC-EXAM/01 notice must you serve with your
current employer?
One week

WHO SHOULD COMPLETE THIS

FORM

Only persons wishing to apply for

B. PERSONAL INFORMATION
an advertised position in a
government department.
Surname MOTSUMI
ADDITIONAL INFORMATION
First Names BETHA JANE
This form requires basic
information. Candidates who are
selected for interviews will be
Date of Birth 1973/07/26
requested to furnish additional
2
certified information that may be ID number 7307260656089
required to make a final selection.
3
Race African White Coloured Indian
SPECIAL NOTES
3
1 – All information will be treated Gender FEMALE MALE
with the strictest confidentiality
and will not be disclosed or used 3
Do you have a disability? YES NO
for any other purpose than to
assess the suitability of a person,
except in so far as it may be Are you a South African Citizen? YES NO
required and permitted by law.
Your personal details must If no, what is your
correspond with the details in your Nationality
ID or passport. And do you have a valid work
YES NO
Permit?
2 – Passport number in the case of
non-South Africans. Have you ever been convicted of a
criminal offence or been dismissed YES NO
3 – This information is required to form employment? 4
enable the department to comply
with the Employment Equity Act, If your profession or occupation
1998. requires State or official
registration, provide date and
4 – This information will only be particulars of registration.
taken into account if it directly
relates to the requirements of the
position.

5 – Applicants with substantial C. HOW DO WE CONTACT YOU

qualifications or work experience
must attach a CV. Preferred language for correspondence? English
Telephone number during office hours (073) 260 1482
Preferred method for
Post E-mail Fax
correspondence
Correspondence contact
details (in terms of above) janebethamotsumi@gmail.com
D. LANGUAGE PROFICIENCY – state ‘good’, ‘fair’ or ‘poor’
Languages (specified)
English Afrikaans Setswana Sotho Xhosa Zulu
Speak Good Fair Good Good Fair Fair
Read Good Fair Good Good Fair Fair
Write Good Fair Good Good Fair 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
Phahama Senior Secondary Grade 12
School 1994

Tertiary education (complete for each qualification you obtained)

Year
Name of Institution Name of Qualification
Obtained
WESTCOL TVET COLLEGE MANAGEMENT ASSISTANT 2014
WESTCOL TVET COLLEGE FINANCIAL MANAGEMENT 2016

Current study (institution and qualification)

5
F. WORK EXPERIENCE (please ignore if you have attached a CV with these details)
Employer (including From To Reason for
Post held
current employer) MM YY MM YY Leaving
LEPORUNG CONSTRUCTION AND SUPPLY ADMINISTRATIVE CLERK NOV 2021 TO DATE
WEST RAND DISTRICT MUNICIPALITY CALL CENTRE AGENT NOV 2017 NOV 2018 END OF CONTRACT

CARLTONVILLE CAMPUS ADMINISTRATIVE CLERK MAY 2017 JUNE 2017 END OF CONTRACT
KRUGERSDORP WEST CAMPUS ADMIN AND EXAM CLERK FEB 2013 FEB 2015 END OF CONTRACT

If you were previously employed in the Public Service, indicate whether

YES NO
any condition exists that prevents your re-employment
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)
Mr. A LEBAKENG CAMPUS MANAGER 082 567 3905
MS ABEA WILLIAMS SUPERVISOR 0782577 468
Mr. SILAS LETSHABISA MANAGER 072 062 5101

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: 25/05/2023