A.
THE ADVERTISED POST (All sections of this form are compulsory)
Position for which you are applying (as Department where the position was advertised
advertised)
WHAT IS THE PURPOSE OF THIS FORM
To assist a government department in
selecting a person for an advertised post.
Reference number (as stated in the advert) If you are offered the position, when can you
This form may be used to identify candidates start OR how much notice must you serve
to be interviewed. You need to fill in all with your current employer?
sections of this form completely, accurately Immediately
and legibly. This will help to process your
application fairly.
.
WHO SHOULD COMPLETE THIS FORM
B. PERSONAL INFORMATION¹
Only persons wishing to apply for an
Mtolo
advertised position in a government Surname and Full names
department. Vuyane Donald
Identity
0 3 0 5 0 7 6 2 2 9 0 8 0
Date of Number
ADDITIONAL INFORMATION DD/MM/YY
Birth 07/05/03 Passport²
N / A
number
This form requires basic information.
Candidates who are selected for interviews Race⁵ African White Coloured Indian Other
will be requested to furnish additional certified Gender³ Female Male
information that may be required to make a
final selection. Do you have a disability? Yes No
SPECIAL NOTES Are you a South African citizen? Yes No
If no, what is your nationality? N/A
1 - All information will be treated with the Do you have a valid work permit? (only if non-South African) Yes N/A No
strictest confidentiality and will not be
disclosed or used for any other purpose than Have you been convicted or found guilty of a criminal offence Yes No
to assess the suitability of a person, except in (including an admission of guilt)?⁵
N/A
so far as it may be required and permitted by lf yes (provide the details)
law. Your personal details must correspond Yes No
with the details in your ID or passport. Do you have any pending criminal case against you?
lf yes, (provide the details)⁵ N/A
2 - Passport number in the case of non- Have you ever been dismissed for misconduct from the Public
South Africans. Yes No
Service?² . .
3 - This information is required to enable the lf yes (provide the details)⁶ N/A
department to comply with the Employment Yes No
Equity Act,1998. Do you have any pending disciplinary case against you?
If yes, (provide the details) N/A
Have you resigned from a recent job pending any disciplinary Yes No
4 -- This information will only be taken into
account if it directly relates to the proceeding against you? ⁴
N/A
requirements of the position. lf yes, (please note that the provisions of the Public Service
Act shall apply)
5- The Executive Authority shall consider the Have you been discharged or retired from the Public Service Yes No
criminal record (s) against the nature of the on grounds of lll-health or on condition that your cannot be re-
job functions in line with internal information employed?⁴
security and disciplinary code.
Are you conducting business with the State or are you a Yes No
Director of a Public or Private company conducting business
N/A
6- The applicant may submit additional with the State?⁶ lf yes, (provide the details)
information separately where the space
In the event that you are employed in the Public Service, will Yes N/A No
provided is not sufficient. you immediately relinquish such business interests?
7- Departments must accept certified Private Public Sector
Please specify the total number of years of experience you Sector
documents that accompany the
have N/A N/A
application(s) with certification that is up
to 6 months, unless the advert prescribes If your profession or occupation requires official registration, Date Reg. No
a longer period. provide date and particulars of registration N/A N/A
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8- Each application for employment form C. CONTACT DETAILS AND MEDIUM OF COMMUNICATIONS
must be duly signed and initialed by the
applicant. Failure to sign this form may lead Preferred language for correspondence
English
to disqualification of the application during
the selection process. Method for
correspondence Post E-mail Fax Tel
Contact details (in
terms of the above)
0673413286 or 0754871183
D. SOUTH AFRICAN OFFICIAL LANGUAGE PROFICIENCY – state ‘’, ‘fair’ or ‘poor’
Languages (specify)
Sesotho English Afrikaans
Speak Good Good Fair
Write or read Good Good Fair
E. FORMAL QUALIFICATION⁷ (from highest to the lowest)
Name of School/Technical College Name of qualification obtained Year obtained
Kgorathuto secondary school National Senior Certificate 2022
. . .
. . .
. . .
Current study (institution and qualification): N/A
F. WORK EXPERIENCE (Also attach a detailed CV)⁶
Employer (including current Post held From To Reason for leaving
employer)
MM YY MM YY
. . .
nntxt nntxt nntxt nntxt nntxtnntxt .nntxt
. . .
. . .
nntxt nntxt nntxt .[Link] .nntxt
. . .
nntxt nntxt nntxt .[Link] .nntxt
If you were previously employed in the Public Service, is there any condition that prevents your re-
Yes No
appointment
If yes, Provide the name of the previous employing department and indicate the N/A
nature of the condition.
G. REFERENCES
Name Relationship to you Tel. No. (office hours)
none none 1234567890
none none 1234567890
none none 1234567890
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 provided will result in my application being disqualified or disciplinary action taken against me if I am appointed:
Signature: Date: 07/11/2025
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