ADDRESS TO: TEL: (013) 249 6981 or 249 7021 or 249 7229
THE MUNICIPAL MANAGER
FOR ATTENTION: HUMAN RESOURCE MANAGEMENT SERVICES web: [Link]
P O BOX 14
MIDDELBURG
1050 APPLICATION FOR EMPLOYMENT
CONFIDENTIAL
Please note:
The purpose of this form is to assist a municipality in selecting candidates for an advertised post.
This form must be completed in full, accurately and legibly. All substantial information relevant to a candidate must be provided in this form. Any additional
information may be provided on the CV.
NO ORIGINAL certificates should be attached to this form, but certified copies thereof must be attached.
Shortlisted candidates may be requested to furnish additional information that will assist the municipality to expedite recruitment & selection processes
Only applications for advertised vacancies with reference numbers will be accepted.
A separate application form should be completed for each post you apply for
All information received will be treated with strictly confidentiality and will not be used for any other purpose than to assess the suitability of the applicant
This form is designed to assist municipality with the recruitment, selection and appointment of staff members in terms of the Municipal Systems Act, 2000 (Act
no.32 of 2000)
Advertised position: …….………………………………………………………….… Ref. No. : ………………………………..
Salary scale advertised: R……………….…………………………………………….……………………………………
Are you prepared to accept appointment on minimum notch of scale (yes) (no)
If no, indicate notch required : R………………… Earliest date on which duty can be assumed : ………………………….
INTERNAL EMPLOYEES Pay number: ………………………… Current position: …………………………………………………………………….
Employment status (indicate √) Permanent Temporary Contract
A. PERSONAL PARTICULARS
Surname: ID no:
First Names: Known as
Married Single Are you a South African citizen? Yes or No: ………. If No, what is your nationality………………………..
If you are not a South African, do you have a valid work permit? Yes or No
Postal Address: …………………………………………………………………………………………………………………………………………………………………..
…………………………………………………………………………………..…… Postal code: ………………………………….………………
Residential Address: ………………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………… Postal code: ……………………………….…………………
Telephone numbers: Home: …………………………………..…… Work: …………………..…………………… Cell: ………………………..…………………………
Email address: ……………………………………………………………………..
Kindly furnish the name of an alternate contact person in the event of you not being available at the above telephone number:
Name: ……………………………………………………………………………….. Telephone no.: ………………………………….………………………………………..
B. EMPLOYMENT EQUITY MONITORING INFORMATION
Race: Please indicate with √ African Coloured Indian White
Gender: Please indicate with √ Male Female
Do you have Disability? Yes or No If Yes please provide details
…………………………………………………………………………………………………………………………………………………………………………………..…………
…………………………………………………………………………………………………………………………………………………………………………………………..…
C. SECONDARY & TERTIARY QUALIFICATIONS
Town: Province:
Name of School
Highest Std/Grade Passed Date obtained
Name of Tertiary Institution(s)
Qualification obtained:
Date obtained:
Subjects passed: MAJOR OTHERS
IF YOU ARE STUDYING AT PRESENT, GIVE FULL DETAILS:
……………………………..………………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………………………………………..…
APPRENTICESHIP / LEARNERSHIP / OTHER
Qualified Unqualified Please indicate with √
Trade: ……………………………………………………………………………………..………………………
Name of Institution: …………………………………………………………………………… Registration date: …………………………………………………………………..
Other qualifications obtained: ………………………………………………………………………………………………………………………………………………………….…
Are you a member of a professional association? Yes No If Yes please provide details:…………………………………………………………….
……………………………………………………………………………………………………………………………………………………………………………………………………..
D. RECOGNITION OF PRIOR LEARNING
State clearly any relevant knowledge and skills obtained that can be linked to the requirements as advertised.
Knowledge of: Skilled in: (e.g. computers, supervision)
…………………………………………………………………………….……… …………………………………………………………………………….………
…………………………………………………………………………………… …………………………………………………………………………………….
E. GENERAL
Language proficiency
Please indicate with √ English Other: _______________________ Other: ____________________________
Good Fair Weak Good Fair Weak Good Fair Weak
Write
Read
Speak
Understand only
Are you in possession of a driver’s licence? Yes / No Date issued: ………………………………………………. Type: ……………………………………………………
Are you in possession of a PDP licence? Yes / No Date issued: ………………………………………………….. Expiry Date: ………………………………………
F. DISCIPLINARY AND CRIMINAL RECORD (COMPULSORY)
Have you ever been convicted of a criminal offence in a court of law during the past 10 years? Yes / No If Yes, state the type of criminal Act
………………………………………………… Date criminal case finalised…………………………..Outcome/judgment:………………………………………
Have you been dismissed for misconduct during the past 10 years? Yes / No If yes, Name of Employer………………………………………Type of
misconduct/transgression………………………………. Date of Resignation /Disciplinary case finalised………………………….
Did you resign from your job pending finalisation of the disciplinary proceedings? Yes / No. If yes, provide details on a separate sheet
G. WORKING EXPERIENCE / EMPLOYMENT RECORD
Yes No
Are you presently employed? Please indicate with √
Current / Last Employer Position held Nature of duties Period of service
Name: ……………………………………………………………... …………………………………… ……………………………………………………………………… From: …………………………
Address: …………………………………………………………... …………………………………… ……………………………………………………………………… To: …………………………….
……………………………………………………………………… …………………………………… ………………………………………………………………………
Reason for change/leaving:
Tel. No.: …………………………………………………………… …………………………………….. ………………………………………………………………………. …………………………………
…………………………………
Previous Employer(s) Position held Nature of duties Period of service
Name: ……………………………………………………………... …………………………………… ……………………………………………………………………… From: …………………………
Address: …………………………………………………………... …………………………………… ……………………………………………………………………… To: …………………………….
……………………………………………………………………… …………………………………… ………………………………………………………………………
Reason for change/leaving:
Tel. No.: …………………………………………………………… …………………………………….. ………………………………………………………………………. …………………………………
…………………………………
Name: ……………………………………………………………... …………………………………… ……………………………………………………………………… From: ……………………………….
Address: …………………………………………………………... …………………………………… ……………………………………………………………………… To: ………………………………….
……………………………………………………………………… …………………………………… ………………………………………………………………………
Reason for change/leaving:
Tel. No.: …………………………………………………………… …………………………………….. ………………………………………………………………………. ………………………………..……
……………………………………….
Name: ……………………………………………………………... …………………………………… ……………………………………………………………………… From: ……………………………….
Address: …………………………………………………………... …………………………………… ……………………………………………………………………… To: ………………………………….
……………………………………………………………………… …………………………………… ……………………………………………………………………… Reason for change/leaving:
………………………………..……
Tel. No.: …………………………………………………………… …………………………………….. ……………………………………………………………………….
……………………………………….
H. REFERENCES
I hereby declare that all information provided in this application and any attachments in support thereof is to the best of my knowledge true and correct. I understand that any misrepresentation or
failure to disclose any information may lead to my disqualification or termination of my employment contract, if appointed.
I hereby give permission to the Steve Tshwete Local Municipality to contact any person at my current or previous employer(s) and/or relevant institution to obtain a detailed reference regarding my
general conduct, work performance-history, behaviour etc. With the exception of the following, who must not be contacted:
______________________________________________________________________Reason:_______________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________
I also give consent that this information together with any relevant information like findings by a medical practitioner, criminal record and any other relevant information be made available to Steve
Tshwete Local Municipality.
The following people may be contacted for reference purposes:
Name : Initials & Surname Position Institution Contact numbers
1.
2.
3.
I. DECLARATION
I hereby confirm that the following people who are involved in the activities of the Steve Tshwete Local Municipality either as a Councillor or an official, are related to me.
NONE:
NAME & SURNAME RELATIONSHIP POSITION OR DESIGNATION DEPARTMENT
1. __________________________ ______________________ ___________________________ ______________________
2. __________________________ ______________________ ___________________________ _____________________
SIGNATURE: …………………………………………………………….. DATE: ……………………………………………...
NB : Please initial each page in the right hand bottom corner and sign next to each correction made by you on this form.