1. This form must be fully, accurately and legibly completed by the applicant. 2. If the space allowed for any item is inadequate, an annexure may be attached. 3. Certified (not older than six months) copies of identity document, qualifications and supporting documents to be attached.4. Attach an updated Curriculum Vitae (CV) with detailed roles and responsibilities and a minimum of three (3) contactable references, including current employer.

APPLICATION FOR A POSITIONSTRICTLY CONFIDENTIAL

SECTION 1: THE ADVERTISED POST:

SECTION 3: PERSONAL DETAILS:

Surname:

Position applied for (as advertised):

If yes, specify the post reference numbers:

Did you apply for any other post in this advertisement?

First Names:

Residential/Postal address:

Postal Code:

Contact No.(s):

Email:

Nationality:

Place of birth:

Do you have a valid work permit (if applicable:)

Date of birth:

Do you have a disability?

If yes, state what kind of disability:

Driver’s licence code:

Own transport:

SARS Tax number:

Marital Status:

Gender:

Identity number:

Fax:

Work:

Yes No

Yes No

Yes No

Yes No

Male Female

Race: African White Coloured Indian

Unmarried Married Widowed Divorced

Reference No:

SECTION 2: MEETING POST REQUIREMENTS:

Do you meet the requirements of the post as advertised? Yes No

Minimum academic qualification(s) Yes No

Minimum relevant experience Yes No

Professional registration (if applicable) Yes No

Knowledge, skills and competencies Yes No

Driver’s licence (if applicable) Yes No

Professional body (active membership only):

Registration Number:Category:

Have you ever been dismissed from employment?

If yes, state the details:

If yes, state the details:

Are there any disciplinary actions against you (pending/convicted)?

Have you been convicted of a criminal offence? Yes No

Yes No

Yes No

SECTION 4: EDUCATION DETAILS:

1.

Name of School: Highest qualification obtained: Year obtained:

1.2.

3.

4.

5.

6.

4.2: DETAILS OF POST-MATRIC QUALIFICATIONS: (attach certified certificate/s)

4.1: FULL DETAILS OF SCHOOL LEAVING QUALIFICATION:

4.4: OTHER RELATED COURSES/TRAINING (attach certified certificate/s)

4.3: CURRENT STUDIES (INSTITUTION AND QUALIFICATION):

Name of Institution: Name of qualification: Area of Specialisation: Year obtained:

1.2.

3.

4.

Name of Institution: Name of course/training: Area of Specialisation: Year obtained:

1.2.

Name of Institution: Name of qualification: Area of Specialisation:

SECTION 5: LANGUAGES PROFICIENCY

Languages: Speak (Y/N): Write (Y/N):Read (Y/N):

Year to complete

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SECTION 10: ADDITIONAL INFORMATION

SECTION 11: 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:

Have you previously been employed by the SANC?

If so, state period(s):

Are any of your previous colleague(s) currently employed by the SANC?

If so, state their names and relationship:

SECTION 8: REFERENCES (Start with the current employer, state only the direct or indirect supervisor).

01 Name and Surname:

Position:Company/Organization:

Physical Address:

Physical Address:

Name and Surname:

Position:Company/Organization:

Telephone Number: Email:

Telephone Number: Email:

02

Company Name Designation Services Date of Registration Remuneration

Remuneration

SECTION 9: COMPANY DECLARATION

From: To:

Yes No

Yes No

Are any of your friends currently employed by the SANC?Yes No

Are any of your relatives currently employed by the SANC?Yes No

Are you related to any Council Member?Yes No

SANC (2019-12-16)

9.1: COMPANIES OWNED BY YOU/IMMEDIATE FAMILY MEMBERS:

Company Name Designation Services Telephone No.

9.2: REMUNERATION OUTSIDE WORK (e.g. AS A BOARD MEMBER OR INDEPENDENT MEMBER, IF A COMMITTEE)

1.

2.

3.

1.

2.

3.