APPLICATION FORM FOR EMPLOYMENT
TERMS AND CONDITIONS
1. The purpose of this form is to assist a Municipality in selecting suitable candidates for
an advertised post.
2. 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.
3. Candidates shortlisted for interviews may be requested to furnish additional information
that will assist Municipalities to expedite recruitment and selection processes.
4. 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.
A. DETAILS OF THE ADVERTISED POST (as reflected in the advertisement)
Advertised post applying for
Reference Number
Name of Municipality
Notice Service Period
B. PERSONAL DETAILS
Surname
First Names
ID or Passport Number
Race African Coloured Indian White
Gender Female Male
Do you have a disability? Yes No
If yes elaborate
Are you a South African citizen? Yes No
If no what is your Nationality?
Work Permit Number (if any)
Do you hold a professional membership with any Yes No
professional body? If yes provide information below:
Professional Body Name: Membership Number: Expiry Date:
C. CONTACT DETAILS
Preferred language for correspondence?
Telephone Number During Office hours
Preferred Method for correspondence Post E-mail Fax
(Mark with an X)
Correspondence Contact Details (in
terms of the above)
D. QAULIFICATIONS (Additional information may be provided on your CV)
Name of school/ Technical College Highest Qualification Obtained NQF Level Year Obtained
TERTIAL QUALIFICATIONS
Name of Institution Name of Qualification NQF Level Year Obtained
E. WORK EXPERIENCE (additional information may be provided on your CV)
Employer (starting with the most Position From To Reason for
recent) Leaving
MM YY MM YY
If you were previously employed in Local Government, Yes No
indicate whether is there any condition exists that
prevents your re-employment:
If yes, provide the name of the previous employing Municipality/Entity
F. DISCIPLINARY RECORD
Have you been dismissed for misconduct on or after 5 July 2011? Yes. No
Have
If yes,you been
Name of Municipality / Institution:
have
Did you resign from your job on or after 05 July 2011 pending Yes No
finalization of any disciplinary proceedings against you?
If yes, provide details on a separate sheet.
G. CRIMINAL RECORD
Were you convicted of a criminal offence involving financial Yes No
misconduct, fraud or corruption on or after 5 July 2011? If yes,
provide details on a separate sheet
Did you resign from your job on or after 05 July 2011 pending Yes No
finalization of a criminal offence involving financial misconduct, fraud,
or corruption against you? If yes, provide details on a separate
sheet.
If yes, type of criminal Act
Date criminal case finalized
Outcome / judgment
H. REFERENCE
Name of reference Relationship Tel (office hours) Cellphone Number Email
I. DECLARATION
I hereby declare that all the 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.
Signature: Date: