FIXXR Technologies pty (Ltd)

Company Registration: 2018 /6084/ 43

Contact number: +27 60 043 4632
Email: hi@fixxr.co.za

FIXXR Mechanic Application form

Section A

Full names: ……………………………………………………………………………………..

Date of Birth: ………………………………………………………………………………………
Identity/ Passport number: ……………………………………………………………………………………..
Contact details: ……………………………………………………………………………………..
Email address: ………………………………………………………………………………………
Physical Address: ………………………………………………………………………………………
……………………………………………………………………………………..
………………………………………………………………………………………
Do you have a criminal record? If yes, please provide details and reasons for the criminal
record:
………………………………………………………………………………………….
………………………………………………………………………………………….

Are you a South African citizen? If not, please indicate which country you are from:
…………………………………………………………………………………………………………………………………………………….
If you are not South African are you legally authorized to work in South Africa and what type
of documentation or permits do you possess? I.e. do you have a South African permanent
residence permit, or a South African work permit etc…)
…………………………………………………………………………………………………………………………………………
 Section B

Do you have a registered Company? ...............................................................................................

If so, Company name: ………………………………………………………………………………………….
Company registration number: …………………………………………………………………………………………..
Physical Address: …………………………………………………………………………………………
…………………………………………………………………………………………..
…………………………………………………………………………………………..
Business Banking Details:
Bank:
…………………………………………………………………………………………..
Account name: ………………………………………………………………………………………….
Account number: ………………………………………………………………………………………….
Branch code: ………………………………………………………………………………………….

How long have you been operating? ………………………………………………………………………………………….

Section C

Do you have any mechanic accreditations? E.g., RMI, MIWA.. etc.

……………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………

Please provide us with details of your previous work experience.

Company Duration Job Description

Please provide us with three work references, this could also be clients you have provided
mechanical services to.
Reference 1: …………………………………………………………………………………………..
…………………………………………………………………………………………..
…………………………………………………………………………………………..

Reference 2: …………………………………………………………………………………………..
…………………………………………………………………………………………..
………………………………………………………………………………………….

Reference 3: …………………………………………………………………………………………
…………………………………………………………………………………………
………………………………………………………………………………………….

Mechanic Tool Checklist:

Tool Yes No
Diagnostic Machine
Car Battery Tester
Circuit Tester
Jumper Cables
Tyre Pressure and Thread
Tester
Power Tools Set (118 set)

Mechanic Application Checklist

Please make sure you hand in the following, along with your application form:
• Certified Copy of your South African ID or International Passport
• Certified copy of your work permit or your permanent residence permit. (If you are not
a South African Citizen)
• Copy of your Police Clearance certificate
• Company registration documents
• Copy of any mechanic certification (e.g Mechanic Technician Certificate)

May you please send through the application form to bayabulela@fixxr.co.za