A.

THE ADVERTISED POST

Position For Which You Are Applying Department where the
(As Advertised) position was advertised:
WHAT IS THE PURPOSE OF
THIS FORM

To assist a government
department in selecting a Reference number (as stated in the If you are offered the
person for an advertised post.
advert) position, when can you
This form may be used to start OR how much
identify candidates to be inter- notice must you serve
viewed. Since all applicants with your current
cannot be interviewed, you
need to fill in this form
employer?
completely, accurately and
legibly. This will help to process
your application fairly.

WHO SHOULD COMPLETE

THIS FORM B. PERSONAL INFORMATION (please ignore if you have
attached a CV with ALL of the following information) 1
Only persons wishing to apply Surname
for an advertised position in a
government department. First names
Date of birth
ADDITIONAL INFORMATION
Identity number2 670723 5514 084
This form requires basic 3
information. Candidates who are Race African White Coloured Indian
selected for interviews will be Gender 3
Female Male
requested to furnish additional
certified information that may be Do you have a disability?3 Yes No
required to make a final
Are you a South African citizen? Yes No
selection.
If no, what is your nationality?
SPECIAL NOTES
And do you have a valid work permit? Yes No
1 – All information will be treated Have you been convicted of a criminal offence Yes No
with the strictest confidentiality or been dismissed from employ-ment?4
and will not be disclosed or used If your profession or occupation requires State
for any other purpose than to
asses the suitability of a person,
or official registration, provide date and N/A
except in so far as it may be particulars of registration
required and permitted by law.
Your personal details must
correspond with the details in
your ID or passport.
C. HOW DO WE CONTACT YOU
2 – Passport number in the case
of non-South Africans. Preferred language for correspondence?

3 – This information is required Telephone number during office hours

to enable the department to
comply with the Employment
Preferred method for
Post E-mail Fax
Equity Act, 1998. correspondence

4 – This information will only be

taken into account if it directly
relates to the requirements of Correspondence
the position. contact details (in terms
of above)
5 – Applicants with substantial
qualifications or work experience
must attach a CV.
D. LANGUAGE PROFICIENCY – state ‘good’, ‘fair’, or ‘poor’
Languages (specify)

Speak
Read
Write

E. QUALIFICATIONS5 (please ignore if you have attached a CV with these details)

Name of School/Technical College Highest qualification obtained Year obtained
GRADE 12
Tertiary education (complete for each qualification you obtained)
Name of institution Name of qualification Year obtained
See attached CV

Current study (institution and qualification):

F. WORK EXPERIENCE5 (please ignore if you have attached a CV with these details)
Employer (including Post held From To Reason for
current employer) leaving
MM YY MM YY

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