CONFIDENTIAL
PO Box 392
UNISA
0003
South Africa
APPLICATION FOR A PERMANENT ADMINISTRATIVE OR PROFESSIONAL POST
IMPORTANT: Applicants are requested to complete the form in full. (The University reserves the right not to
consider incomplete applications).
Write or print in black ink only.
Attach certified copies of official statements of subjects and symbols, diploma or degree certificates conferred.
Send the completed application form to the Directorate: HR Staffing, to the address indicated in the
advertisement.
Should you wish to apply for a post in more than one department, complete a separate form for each.
Applications will only be considered for advertised posts.
1. PERSONAL PARTICULARS
TITLE: SURNAME
FULL NAMES
ID/PASSPORT NUMBER
RESIDENTIAL ADDRESS POSTAL ADDRESS
Tel: Home Work Fax
Cell E-mail
2. PARTICULARS OF POST APPLIED FOR:
REFERENCE NO:
DEPARTMENT: JOB TITLE:
WHAT IS THE MINIMUM SALARY THAT YOU WILL CONSIDER? (p.a.)
Basic…………………………………………………………………………………
Total package……………………………………………………………………….
3. DETAILS OF PRESENT POSITION (if applicable)
EMPLOYER: ADDRESS:
POSITION: AS FROM:
4. OCCUPATIONAL EXPERIENCE
POSITION FROM TO
EMPLOYER (Capacity and/or type of work)
YEAR MONTH YEAR MONTH
4.1 RELEVANT OCCUPATIONAL EXPERIENCE APPLICABLE TO THIS POST:
1
4.2 OTHER OCCUPATIONAL EXPERIENCE
5. SCHOOL EDUCATION
Highest standard/grade passed: Month: Year: Country:
Subjects passed Symbol Subjects passed Symbol
1. 5.
2. 6.
3. 7.
4. 8.
6. POST SCHOOL EDUCATION (Completed)
DEGREE/ INSTITUTION YEAR FIRST NORMAL * MAJOR SUBJECTS
DIPLOMA/ ENROLLED DURATION F/P
CERTIFICATE
* full-time study must be indicated by ‘F’ and part-time by ‘P’.
7. CURRENT AND/OR INCOMPLETE STUDIES (if applicable)
DEGREE/ INSTITUTION YEAR NORMAL * MAJOR SUBJECTS
DIPLOMA/ FIRST DURATION F/P
CERTIFICATE ENROLLED
* full-time study must be indicated by ‘F’ and part-time by ‘P’.
8. LANGUAGE PROFICIENCY
2
Indicate language and level of proficiency, i.e. ability to speak, read, write, poor, average, very good:
9. OTHER SKILLS
Please give details of any other skills that you may have (e.g. computer skills)
10. Applicants are required to indicate to what extent their qualifications and experience meet the requirements
of the post. Please structure your response according to the requirements as set out in the advertisement:
11. EMPLOYMENT EQUITY INFORMATION (This information is required to enable the University to comply with
the requirements of the Employment Equity Act, Act 55 of 1998)
Race African White Coloured Indian
Gender Female Male
Are you a South African citizen? Yes No (please provide further
details as to current status
If you are not a citizen by birth, please indicate the date under Additional
you acquired your citizenship ……………………………. Information)
Are you a person with a disability? Yes (please provide further No
details under Additional
Information)
12. ADDITIONAL INFORMATION
3
Furnish any additional information which you regard as relevant in support of your application.
13. REFERENCES (Contactable)
NAME RELATIONSHIP TO INSTITUTION/ORGANISATION TELEPHONE/FAX-E-MAIL
APPLICANT
14. FOR RECORD PURPOSES, PLEASE INDICATE HOW YOU BECAME AWARE OF THE VACANCY
15. INSOLVENCY OR ADMINISTRATION
Are you involved in any outside business or activities, or do you have any interests which may
conflict or are likely to conflict with the execution of any official duties, should you be the successful Yes No
candidate for this post?
Have you ever been declared insolvent or have you been or are you currently under administration? Yes No
16. CRIMINAL CASES/OFFENCES
Have you ever been found guilty of a criminal offence? Yes No
If yes, specify the details on a separate memo
16.1 Have you ever had a sentence imposed? (mark with an x)
IMPRISONMENT SUSPENDED ADMISSION OF GUILT OTHER
Period:...........................(eg 2 From ......................... (date) to Amount:
years) ...................................... (date) R........................
Is there any criminal, civil or disciplinary action pending against you? Yes No
If yes, specify the details (eg offence) on a separate memo
Have you ever been found guilty of misconduct at a previous employer? Yes No
If yes, specify the details on a separate memo
17. DECLARATION BY APPLICANT
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CONSENT IN TERMS OF THE PROTECTION OF PERSONAL INFORMATION ACT NO 4 OF 2013
1. I declare that all the personal information furnished by me on this form are true and correct, and I undertake to
inform Unisa of any changes in my personal information.
2. I undertake to comply with all the rules, regulations and decisions of the university and any amendments thereto
and I have taken note of advice which may be applicable to employees in general.
3. I, as an employee of Unisa or an applicant for employment at Unisa, hereby consent that Unisa may collect, use,
distribute, process my personal information for its business purposes, which may include, but is not limited to:
3.1 internal administrative processes pertaining to my employment at Unisa;
3.2 conducting criminal, credit and reference checks; and
3.3 institutional and scholarly research.
4 I also consent that Unisa may share my personal information with other Universities of South Africa, the
Department of Higher Education and Training, the South African Qualifications Authority, Qualification Verification
Agencies, Internal and External Auditors, legislative requirements, e.g. the South African Receiver of Revenue,
Department of Home Affairs, Department of Labour, Banks, service providers offering Unisa employees various
services as part of employment benefits such as relevant retirement fund and group life insurance, their appointed
administrator(s), recognised medical aid schemes, the risk benefit insurers, external survey and benchmarking
organisations, employee development service providers, legal entities which may lawfully require such information
for legal obligations and/or investigations and third parties rendering communication facility on behalf of the
university.
5 I understand that in terms of the Protection of Personal Information (POPI) Act and other laws of the country,
there are instances where my express consent is not necessary in order to permit the processing of personal
information, which may be related to investigations, litigation or when personal information is publicly available.
6 I will not hold the university responsible for any improper or unauthorised use of personal information that is
beyond its reasonable control.
7. I confirm that I have read the notice and understand the contents.
Note: The nature of personal information collected can be viewed in the Personal Information Inventory Lists
published on the Unisa webpage at [Link]
NAME
SIGNATURE DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . .