Youth Unemployment Confirmation Form

Email Address:

Names:

Initials:

ID Number:

Previous Employment: None Vacation Part-Time Employment Full-Time Voluntary Work

Please tick Work Employment

Are you currently employed? Yes No If yes, please provide further details:

Have you previously benefited from Yes No If yes, please provide further details:
funding for a Yes Programme(12 Months
Contract) Internship or Learnership?

Have ever participated in any internship? Yes No If yes, please provide further details:
Even for 1 Month!

Do you have a criminal record, have you Yes No I Hereby give consent to use my Yes No
previously or recently been convicted or Internship success story and
charged with criminal offence? professional profile photo for
Marketing purposes.

By signing below, I hereby confirm that he information that I have provided in this form is true and correct. I understand that by providing false and inaccurate
information may disqualify me from the programme and could result in disciplinary action being instituted against me.

______________________________ ________________________________ ________________________________

Full Name and Surname: Signature: Date: