G.P.

S 81/971431
Republic of South Africa Z83 (81/971431)
Effective 01 January 2021

APPLICATION FOR EMPLOYMENT

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 DEPARTMENT OF HIGHER
IT TECHNICIAN EDUCATION AND TRAINING
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
start OR how much notice must you serve
1/6P/24 POTCHEFSTROOM with your current employer?
This form may be used to identify candidates CAMPUS
to be interviewed. You need to fill in all 7 DAYS
sections of this form completely, accurately
and legibly. This will help to process your
application fairly.

B. PERSONAL INFORMATION1
WHO SHOULD COMPLETE THIS FORM
NEMASANGO
Surname and Full names
Only persons wishing to apply for an TAKUDZWA TRUST
advertised position in a government Identity
department. Date of Number
DD/MM/YY
Birth Passport2
number
F N 8 8 3 1 4 5
ADDITIONAL INFORMATION
3
Race African White Coloured Indian Other
This form requires basic information. Gender 3
X
Female Male
Candidates who are selected for interviews
will be requested to furnish additional certified Do you have a disability? Yes No X
information that may be required to make a
final selection. Are you a South African citizen? Yes No X
If no, what is your nationality?
SPECIAL NOTES
Do you have a valid work permit? (only if non-South African) Yes X No
Have you been convicted or found guilty of a criminal offence Yes No X
1 – All information will be treated with the (including an admission of guilt)? 5
strictest confidentiality and will not be If yes (provide the details)
disclosed or used for any other purpose than
to assess the suitability of a person, except in Yes No X
Do you have any pending criminal case against you?
so far as it may be required and permitted by If yes, (provide the details)5
law. Your personal details must correspond
with the details in your ID or passport. Have you ever been dismissed for misconduct from the Public Yes No
X
Service?4
2 – Passport number in the case of non- If yes (provide the details)6
South Africans.
Yes No
Do you have any pending disciplinary case against you? X
3 – This information is required to enable the If yes, (provide the details)
department to comply with the Employment
Equity Act, 1998. Have you resigned from a recent job pending any disciplinary Yes No X
proceeding against you? 4
4 – This information will only be taken into If yes, (please note that the provisions of the Public Service
account if it directly relates to the Act shall apply).
requirements of the position.
Have you been discharged or retired from the Public Service Yes No X
on grounds of Ill-health or on condition that your cannot be re-
5- The Executive Authority shall consider the
employed?4
criminal record (s) against the nature of the
job functions in line with internal information Are you conducting business with the State or are you a Yes No X
security and disciplinary code. Director of a Public or Private company conducting business
with the State?6 If yes, (provide the details)6
6- The applicant may submit additional
information separately where the space Yes X No
In the event that you are employed in the Public Service, will
provided is not sufficient. you immediately relinquish such business interests?

7- Departments must accept certified Private X Public Sector

Please specify the total number of years of experience you Sector
documents that accompany the
have
application(s) with certification that is up 5
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

Page 1 of 2
TTN
Initial……….
 Z83 (81/971431)

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
to disqualification of the application during ENGLISH
the selection process.
Method for
Post E-mail Fax Telephone X
correspondence
Contact details (in
terms of the above)
0787324071

D. SOUTH AFRICAN OFFICIAL LANGUAGE PROFICIENCY – state ‘good’, ‘fair’, or ‘poor’

Languages (specify)
ENGLISH
Speak
GOOD
Write or read
GOOD

E. FORMAL QUALIFICATION7 (from highest to the lowest)

Name of School/Technical College Name of qualification obtained Year obtained

AFRICA UNIVERSITY BACHELOR OF SCIENCE IN COMPUTER 2017

INFORMATION SYSTEMS NQF 7
MUTARE BOYS' HIGH ADVANCED LEVEL NQF 4 2012

Current study (institution and qualification):

F. WORK EXPERIENCE (Also attach a detailed CV)6

Employer (including current Post held From To Reason for leaving
employer)
DESKTOP MM YY MM YY
GAUTENG CITY COLLEGE SUPPORT & IT 03 2024 06 2024 SEEKING CAREER GROWTH
LECTURER
BROOKLYN CITY COLLEGE IT LECTURER
01 2024 03 2024 SEEKING CAREER GROWTH
ITRAIN IT CONSULTANCY & NETWORK 2023 MOVING TO SOUTH AFRICA
06 2021 08
TRAINING ADMINISTRATOR
If you were previously employed in the Public Service, is there any condition that prevents your re-
Yes No X
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)

MS RACHEAL SUMBACHUNDU DEPUTY CAMPUS MANAGER 0738655476 0108807292

GCC RUSTENBURG
MR ELIAS KINTU PRINCIPAL BROOKLYN CITY 0636710861
COLLEGE RUSTENBURG
MRS MASHAVAVE HEAD OF OPERATIONS ITRAIN +263772383408

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: 2024/06/19

TTN
Page 2 of 2 Initial……….