HR
(R3)
APPLICATION FOR EMPLOYMENT
The information below will be treated in the strictest confidence.
Please note that applications for employment are only received on this official application form.
A separate application form must be completed for each vacancy.
Designation of
post
Reference Department
number
Personal Particulars:
Other
Title
Dr Prof Assoc. Prof Rev Mr Mrs Ms/Miss (Specify)
Surname Maiden
name
Date of
Name
Birth
Race African Coloured Indian White Other (Specify)
Gender*(Stats) Male Female Id/Passport number
Postal Address Physical Address
Home Number Cell Number Email Address
Marital Status No of dependents
Citizenship Work permit: (valid) Yes No
If not South African – Do you have permanent residency Yes No
Driver’s license Yes No
Are you currently applying for another position within our
Yes No
organization? If yes, could you please provide more details?
Vacancy : ___________________________ Department:_____________________
Department:
Do you currently work at DUT? Yes No
Position:
Do you have family members or relatives Department:
Yes No Position:
employed at DUT?
Have you ever been convicted of a Yes No Specify
criminal offence? If yes specify
Have you ever been dismissed from any Yes No Specify
employment?
If yes specify
Is there any other disclosure of Yes No Specify
circumstances you would like to make the
Selection Committee aware of?
Do you have any disability you would like to Yes No Specify
declare?
Disability Status Is the Physical, if yes Yes No Specify
nature of specify
your Mental, if yes specify Yes No Specify
impairment
Combination of both, Yes No Specify
if yes specify
Is the Temporal, if yes Yes No Specify
nature of specify
your Permanent, if yes Yes No Specify
impairment specify
Is the nature of your Yes No If your impairment is substantially Yes No
impairment substantially limiting, will you need support to
limiting perform the essential functions of
your job should you be appointed?
Have you ever been medically Yes No Specify
boarded, if yes specify
Qualifications and Experience
Please complete this section in full. Do not complete with “Refer to CV”
Qualifications will be verified during the selection and appointment process
Senior Certificate/Degree/Diploma/Other qualification
obtained Institution Year completed
and (Add appendix if required)
Professional Registration
e.g. HPCSA (Health Professional Council of South Africa)
Category of Registration Registering Body Date of Registration
Employment History
List in chronological order with the current/Most recent first Do not complete with “Refer to CV”
Company/Institution Position Dates of employment
From To
Month/Year Month/Year
Dat Mont Yea Dat Mont Yea
e h r e h r
Publications : (Attach separate sheet if space not sufficient) Note: this section is compulso
you are applying for an academic post
A. Authorship or co-authorship of book/s (Please state title, publisher and date)
B. Contributions to scientific professional journals (Please furnish title of contribution, name, year an
volume of journal and, if possible, page reference)
C. Important unpublished reports and memorandums
Detail of Current Conditions of Service
Name of present employer Your present
occupational title
Your present basic salary per annum Salary range
Financial Annual Fringe Benefits
1) R
2) R
3) R
4) R
TOTAL R
What is the minimum starting salary would
you consider?
Would you be open to being considered for Y No Reason:
a position at a lower level? If no please
es
furnish reason/s:
Present period of notice with your current
employer?
Earliest date on which duties can be
assumed?
Financial contractual obligations with
present employer
Language Proficiency Speak Read Write
A.
B.
C.
Referees
Title and Name Position and Email address Contact number
company/Institution
1) Cell :
Landline:
2) Cell :
Landline:
3) Cell :
Landline:
CERTIFICATION AND ACKNOWLEDGMENT
I, the undersigned, hereby certify that all the information furnished on this application form is
complete and correct and accept that the furnishing of any false information or the withholding
of relevant or material information will render me liable to disqualification or dismissal, if
appointed.
Please note that:
1. All sections in this form must be completed in full and signed by the applicant.
2. Clear certified copies of identity documents, educational certificates, professional bodies stated in this
form must be attached. Incomplete or late applications will not be considered.
3. Documents submitted with applications, including curriculum vitae, will not be returned.
4. Applicants must meet the minimum requirement/s indicated in the advertisement before lodging an
application.
5. Only short-listed candidates will be contacted.
6. DUT University reserves the right to verify the authenticity of all documents submitted,
7. “The University reserves the right not to appoint” or to re-advertise to widen the pool of applicants
8. Verification will be conducted on preferred candidates only. DUT reserves the right to do a complete
verification of the information you have provided. By completing and submitting this form you authorize
DUT to submit your personal details to our external service providers to verify your identity,
qualifications, previous criminal convictions and any other data related to minimum requirements.
9. DUT reserves the right to contact your referees or request additional referees.
[Link] DUT strives for equal opportunities, preference will be given in terms of the University’s Equity
Policy”