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Cyber Minds Application for New Licensee:Dear Applicant,
Please provide us with the following information to allow us to get to know you better. Your personal information will be kept confidential and not shared with another entity.
You can complete the form electronically or if you prefer, you can print it out and complete it by hand.
Submit the completed form and a short CV by e-mail to: [email protected] . Feedback can be expected within 7 days.
Kind Regards,Marius LubbeManaging Director: Cyber-Minds (Pty) Ltd
1. Personal Details
Surname Click or tap here to enter text. Title
Choose an item.
First Names Click or tap here to enter text.
Nationality Click or tap here to enter text.
ID Number / Passport Number Click or tap here to enter text.
E-mail address Click or tap here to enter text.
Telephone NumbersHome Click or tap here to
enter text. Cellular Click or tap here to enter text.
Business Click or tap here to enter text. Other Click or tap here to
enter text.
Residential Address Click or tap here to enter text.
Period at current address: Choose an item.
Residential Property is:
Owned by self ☐ Owned by spouse ☐
Rented by self ☐ Rented by spouse ☐Number of Dependents
Choose an item.
Children’s ages Click or tap here to enter text.
2. Marital StatusCopyright: Cyber-Minds (Pty) Ltd t/a Creative Minds® October 2018 Page 1 of 3
Status Choose an item.
3. If married, please supply the following information about your spouseSurname Click or tap here to enter text.
First Names Click or tap here to enter text.
Name of Employer Click or tap here to enter text.
Current position Click or tap here to enter text.
4. Employment History (from most recent)
Employer From To Position last held Annual Income
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Click or tap to enter a date.
Click or tap to enter a date.
Click or tap here to enter text.
Choose an item.
Click or tap here to enter text.
Click or tap to enter a date.
Click or tap to enter a date.
Click or tap here to enter text.
Choose an item.
Kindly include your CV
5. Education
Highest qualification Choose an item.
6. Computer Literacy
Indicate your level of literacy
Beginner Intermediate Advanced
MS Word ☐ ☐ ☐MS Excel ☐ ☐ ☐MS Outlook ☐ ☐ ☐MS Project ☐ ☐ ☐MS Access ☐ ☐ ☐Sage Accounting ☐ ☐ ☐
Please provide us with details of previous practical Computer, Marketing, Training or Business experience
Click or tap here to enter text.
7. Credit recordHave you ever been blacklisted? ☐ If YES, provide details belowClick or tap here to enter text.
Copyright: Cyber-Minds (Pty) Ltd t/a Creative Minds® October 2018 Page 2 of 3
Have you ever been sequestrated? ☐ If YES, provide details belowClick or tap here to enter text.If YES, have you been rehabilitated? ☐ If YES, provide details belowClick or tap here to enter text.Have you ever been found guilty of a criminal offence? ☐ If YES, provide details belowClick or tap here to enter text.
8. Current business interests
If you currently have interest in another business, please provide the following details
Registered Name Click or tap here to enter text.
Nature of business Click or tap here to enter text.
Shareholding % Click or tap here to enter text.
Value of interest Click or tap here to enter text.
9. FinancingDo you need to apply for financing? ☐ If Yes, please give details below
Click or tap here to enter text.
What will your own cash contribution be? Click or tap here to enter text.
10. MotivationPlease give us a short, personal motivation why you are applying for a Cyber-Minds Training Institute franchise.Click or tap here to enter text.
Copyright: Cyber-Minds (Pty) Ltd t/a Creative Minds® October 2018 Page 3 of 3
