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RSA Citizen?

Yes No

Race

Nationality

You have work permit?

Passport Number

ID number

Date of Birth

Gender

Do you have a disability?

Yes No

Have you been convicted or found guilty of a criminal offence (including an admission of guilt)?

Yes No

Provide details of criminal offence?

Have you ever been dismissed for misconduct from the Public Service?

Yes No

Provide details of previous dismissal?

Do you have any pending criminal case against you?

Yes No

Provide details of pending investigation?

Do you have any pending disciplinary case against you?

Yes No

Provide details of pending disciplinary case?

Have you resigned from a recent job pending any disciplinary proceeding against you?

Yes No

Provide details of when you resigned with pending disciplinary action?

Have you been discharged or retired from the Public Service on grounds of ill-health or on condition that you cannot be re-employed?

Yes No

Are you conducting business with the State or are you a Director of a Public or Private company conducting business with the State?

Yes No

Provide details of your business with the State?

In the event that you are employed in the Public Service, will you immediately relinquish such business interests?

Yes No

Please specify the total number of years of experience you have in Public service

20 or more

Please specify the total number of years of experience you have in Private sector

20 or more

If your profession or occupation requires State or official registration, provide date and particulars of registration.

Reg. Date

Particulars

Languages

Speak

Read

Write

Language	Speak	Read	Write	Edit	Delete
{{(vm.languages \| filter:{languageId: proficiency.languageId})[0].languageDesc}}	{{(vm.languageProficiencies \| filter:{languageProficiencyId : proficiency.speakProficiencyId})[0].languageProficiencyDesc}}	{{(vm.languageProficiencies \| filter:{languageProficiencyId : proficiency.readProficiencyId})[0].languageProficiencyDesc}}	{{(vm.languageProficiencies \| filter:{languageProficiencyId : proficiency.writeReadProficiencyId})[0].languageProficiencyDesc}}

HOW DO WE CONTACT YOU

Preferred language

Alternative Contact Number

Preferred method

Contact details (in terms of preferred method)

QUALIFICATIONS

Name of institution

Type of Qualification

Name of Qualification

Year Obtained

Current Studies?

Yes No

Name of institution	Qualification type	Name of qualification	Year obtained	Edit	Delete
{{qualification.institution}}	{{(vm.qualificationTypes \| filter:{qualificationTypeId: qualification.qualificationTypeId})[0].qualificationTypeDesc}}	{{qualification.nameOfQualification}}	{{qualification.yearObtained}}	Current Studies

WORK EXPERIENCE

Employer

Post Held

From

Reason for Leaving

Current employment

Employer	Post Held	From	To	Reason for Leaving	Edit	Delete
{{experience.employer}}	{{experience.postHeld}}	{{experience.dateFrom \| date : 'yyyy/MM/dd'}}	{{experience.dateTo \| date: 'yyyy/MM/dd'}}	{{experience.reasonForLeaving}}

REFERENCES

Name of reference

Relationship to you

Tel. No. (office hours)

Name of reference	Relationship to you	Tel. No.	Edit	Delete
{{reference.referenceName}}	{{reference.referenceRelationship}}	{{reference.referenceContactNumber}}

If you were previously employed in the Public Service, indicate whether any condition exists that prevents your re-appointment

Yes No

Department name

ATTACHMENTS

Max file size must not exceed 1 MB on each field.

Allowed file types (pdf, doc, docx, jpeg, jpg)

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 supplied could lead to my application being disqualified or my discharge if I am appointed:

I DECLARE

Declaration Date