HR (R2)

FOROFFICIALUSE
1.Date Received: ...... / 2.DateAcknowledged: ...... / 3.Reply sent on: ......

APPLICATION FOR EMPLOYMENT(For all posts)

NOTE: Applicants to note the General Notice circulated separately and the following:

(a) This form must be completed legibly by the applicant (PLEASE PRINT OR TYPE ALL INFORMATION EXCEPT SIGNATURE

(b) Aseparate application form must be used for each vacancy.

(c) Clear certified copies of all educational certificates, certificates of character and service certificates for all periods of service stated on this form,must be attached.

(d) Successful applicants will be required to produceORIGINAL documents, including Book of life, certificates of services, character and educational qualifications for certification purposes and a medical certificate at own cost .

(e) Documents submitted with applications, including curriculum vitae, willnot be returned. (f)Incomplete or late applications will not be considered.

(g) Any false statement made will render a successful candidate to immediate dismissal or disqualification of the application.

(h) Applicants must meet the minimum requirement/s indicated in the advertisement before lodging an application. (i) This University reserves the right to verify the authenticity of all documents submitted, e.g. BAdegree, etc

A. POSTAPPLIED FOR :
1. Designation of Post :
2. Ref No.
3. Department :
4. Permanent,Temporary, Contract :
5. If responding to a composite or consolidated advertisement, indicate which other post/s you have applied for (if applicable)
(i)(ii)(iii)
B. PERSONALPARTICULARS
1. (i)Surname : / Title:
(ii)First Name (s) :
(iii)Maiden Name : / (iv)Identity Number :
(v)State whether SouthAfrican citizen / YES / NO
Ifnot a SouthAfrican citizen - Have you a permanent residence permit / YES / NO
(vi)Nationality :
2. (i)*Gender (For statistical purposes) : / Male / Female
(ii)*Race (For Statistical purpose) :African / Coloured / Indian / White
Other / Specify
*Please tick whichever is applicable
3 (i)BusinessAddress:
Code:
(ii)ResidenceAddress:
Code:
Pleaseindicate which address is preferred for postal purpose :
4. Telephone :Business:Code : / No:
Residence:Code : / No:
Telefax : / Cell: / E-Mail :
5. Date and Place of birth: / 6. Marital Status :
7. ChildrenNumber : / Ages:
8. Have you any physical or mental defect or disease / YES / NO
If“Yes' describe
Statehealth condition:
9. Have you ever been medically boarded, if yes specify / YES / NO
10.Have you ever been:(i) Convicted of a criminal offence? / YES / NO
(ii)Dismissed from any employment? / YES / NO
If“Yes” to (i) or (ii), state reason (s) :
C. PRESENT EMPLOYMENT
1.Name andAddress of present Employer :
Code / :
2.Date of appointment : / Positionheld :
3.Salary Scale :
4.PresentAnnual Earnings (Excluding allowances) : (Please attached most recent salary advice)
D. DRIVER’S LICENCE
DATE OF ISSUE / CODE / LICENCENO. / LICENCEENDORSED (Yes / No)
1.
2.
E.LANGUAGE PROFICIENCY
PROFICIENCYIN LANGUAGES / SPEAK / READ / WRITE / HIGHESTEXAMINATION PASSED
1.English
2.Zulu
3.Other (Indicate)
F.QUALIFICATIONS This section must be completed
NOTE: Certified copies of all educational certificates must be submitted (Note (c) on page 1 refers). If not indicatedon certificate/s, list/s of all subject credits must be furnished.
EDUCATIONALQUALIFICATIONS / INSTITUTION / QUALIFICATIONS / MAJOR SUBJECTS (where applicable) / YEAROF COMPLETION
(1)Secondary /High School
(2)Academic (eg. BA)
(3)Professional (Teaching & Other)
(4)Technical
G. MEMBERSHIPOF PROFESSIONALBODIES, IFAPPLICABLE
INSTITUTION/ SOCIETY / COMMENCEMENT YEAR / TYPEOF MEMBERSHIP
eg.Associate /Fellow
H. DETAILS OF RESEARCH PROJECTS UNDERTAKEN / SCIENTIFIC PUBLICATIONS / PAPERS PRESENTED - IFAPPLICABLE
(Otherthan that for degree/diploma purposes - Use a separate sheet if necessary)
I.EMPLOYMENT HISTORY: Note: If applicable, this section must be completed in chronological order, notwithstanding submission of curriculum vitae/separate list with details. Refer to (Note (f) on page 1
NAMEOF EMPLOYER / POSITIONHELD / EXACTDATES / TOTAL / REASONFOR LEAVING
FROM / TO
Y / M / D / Y / M / D / Y / M / D
TOTALEXPERIENCE:YEARSMONTHSDAYS
1. Tertiary Lecturing experience- years
2. Other Lecturing experience- years
3. Administrativeexperience- years
4. Other experience- years
Give,as concisely as possible, details of your relevant experience in respect of the position applied for . (if considered necessary, attach a separate statement setting out information in greater detail)
J.SCHOLARSHIPS, BURSARIES, FELLOWSHIPSAND OTHERAWARDS
NATURE OFAWARD / DATEAWARDED
K. DETAILS OF PRESENT STUDIES
1. Course of Study :
2. Subjects/modules already passed : .
3. Subjects/modules still to be passed :
4. State when final examinations will be written/ course will be completed / .
L.GENERAL
1. Period of notice required by present employer :
2. Earliest date able to commence duty, if successful :
3. Interest (e.g. sporting, social, cultural)
M. COMPUTER LITERACY
Indicateexperience and /or qualifications
N. REFEREES: Indicate details of 3 persons who may be approached for information on your personal qualitiesand suitability for the post.
Pleaseensure that complete particulars are furnished.
Refereeswill be contacted prior to finalisation of appointment
NAME / POSITION
(Ifapplicable) / PostalAddress and Code / Code andTel. No/ Email/Fax No
1. / Tel
Email
Fax
2. / Tel
Email
Fax
3. / Tel
Email
Fax
O. Where did you read or hear about the vacancy?
P.Do you have any family members or relative employed at this University? / YES / NO
Ifso, state names, departments and how related
Q. FINANCIAL/ CONTRACTUALOBLIGATIONS WITH PRESENT EMPLOYER eg. BURSARIES, SCHOLARSHIP, LOANS, ETC.
1.
2.
3.
4.
R. CERTIFICATIONANDACKNOWLEDGMENT
I,the undersigned, hereby certify that all the information furnished on this application form is correctand 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.
...... SIGNATURE OFAPPLICANT DATE