G.P.-S.

81/97143
Z 83 (81/971431)
REPUBLIC OF SOUTH AFRICA
APPLICATION FOR EMPLOYMENT

A. THE ADVERTISED POST: NO - 02

Position for which you are applying Department where the position was
(as advertised): advertised:

WHAT IS THE PURPOSE OF

THIS FORM

To assist a government department Reference number (as stated in the If you are offered the position, when
in selecting a person for an advert) can you start OR how much notice must
advertised post. you serve with your current employer?

This form may be used to identify Thirty Days’ Notice

candidates to be interviewed. Since
all applicants cannot be interviewed,
you need to fill in this form
completely, accurately and legibly. B. PERSONAL INFORMATION (please Ignore if you have attached a
This will help to process your CV with ALL of the following information)
application fairly. Langa M.J
Surname
WHO SHOULD COMPLETE THIS
FORM First Names
Moshipo Jacob
19967 /07/ 23
Only persons wishing to apply for an Date of Birth
advertised position in a government
670723 5514 084
department. ID number 2

African White
ADDITIONAL INFORMATION Race 3
Coloured Indian
*
This form requires basic Gender 3Male

information. Candidates who are

selected for interviews will be Do you have a disability? 3
YES NO *
requested to furnish additional
certified information that may be
Are you a South African Citizen? YES * NO
required to make a final selection.
If no, what is your
SPECIAL NOTES Nationality
1 – All information will be treated And do you have a valid work Permit?
with the strictest confidentiality and
Have you ever been convicted of a
will not be disclosed or used for any
other purpose than to assess the criminal offence or been dismissed form YES NO *
suitability of a person, except in so employment? 4
far as it may be required and If your profession or occupation
permitted by law. Your personal requires State or official registration,
details must correspond with the provide date and particulars of
details in your ID or passport. registration.
2 – Passport number in the case of C. HOW DO WE CONTACT YOU
non-South Africans.
Preferred language for correspondence? ENGLISH
3 – This information is required to
enable the department to comply Telephone number during office hours 0635 31 4042
with the Employment Equity Act,
1998. Preferred method for
correspondence POST E-Mail * Fax
4 – This information will only be Correspondence contact details
taken into account if it directly (in terms of above
relates to the requirements of the
position. Moshipo.langa@dhsd.limpopo.gov.
za
5 – Applicants with substantial
qualifications or work experience
must attach a CV.
D. LANGUAGE PROFICIENCY – state ‘good’, ‘fair’ or ‘poor’

Languages (specified)
Sepedi English Afrikaans
Speak Good Good Fair
Read Good Good Fair
Write Good Good Fair

E. QUALIFICATIONS 5 (please ignore if you have attached a CV with these details) See Attached
CV
Name of School / Technical College Highest qualification obtained Year Obtained

Tertiary education (complete for each qualification you obtained) See attached CV
Name of Institution Name of Qualification Year Obtained

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: