The Msunduzi Municipality
Private Bag 321
PIETERMARITZBURG
3201
Telephone: 033 3923 000
[email protected] www.msunduzi.gov.za
APPLICATION FOR EMPLOYMENT
NOTES TO APPLICANT
Thank-you for your interest in seeking employment with us
Complete the form in your own handwriting in block letters and in black ink
Mark appropriate answers with an “x” where applicable
For the purpose of the Employment Equity Act (1998) all statistical details should be completed
Please attach certified copies of the following documents together with this application form and indicate which items you have
included by placing an “x” in the space provided
ID Book/ Passport Drivers license
Grade 12 Exam Certificate Certificate of service
Testimonials/References Other
Degree, Diploma or other educational certificates Total number of Pages attached:
POST DETAILS
Position Applied for:
Business Unit:
Date of Advert:
Reference Number:
PERSONAL DETAILS
Name of Candidate:
Postal Address:
Code:
Residential Address:
Code:
Telephone: (h) (w) (c)
E-mail Address:
Date of Birth: Citizenship:
ID Number: Passport Number:
Sex: Race: Disabled: Yes No
If yes, furnish particulars
Drivers license: Yes No Period:
Code: Vehicle Restrictions: PDP: Yes No
PDP Code (G,P,D): Expiry Date:
Language proficiency. In the schedule below, indicate proficiency as “Good”, “Fair”, “Poor” or “None”
Language: Read Write Speak
English:
Zulu:
Page 1 of 5
Other:
EDUCATION AND QUALIFICATIONS
Highest Grade:
Name of School:
Town/ City:
School Education
1.
2. Period From:
Subjects
3.
4.
5. Period To:
6.
Name of Institution:
Qualification:
3. 1.Tertiary Education 1.
(University/Technikon/ 2. Period From:
Subjects
College) 3.
4.
5. Period To:
6.
Name of Institution:
Qualification:
4. 2.Tertiary Education 1.
(University/Technikon/ 2. Period From:
Subjects
College) 3.
4.
5. Period To:
6.
Name of Institution:
Qualification:
3. Tertiary Education 1.
(University/Technikon/ 2. Period From:
Subjects
College) 3.
4.
5. Period To:
6.
4. Other
TRAINING
This includes government training schemes, apprenticeships, short courses
Course Title Organisation From To
MEMBERSHIP OF PROFESSIONAL INSTITUTES
Please indicate whether membership is by examination or qualification
Institute Level of Membership From To
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EXPERIENCE (Start with Latest)
1. Company Name:
Position: Date from: Date to:
Responsibilities:
References: Contact Details:
Basic Salary: (Monthly)
Reasons for leaving: Other Benefits:
2. Company Name:
Position: Date from: Date to:
Responsibilities:
References: Contact Details:
Basic Salary: (Monthly)
Reasons for leaving: Other Benefits:
3. Company Name:
Position: Date from: Date to:
Responsibilities:
References: Contact Details:
Basic Salary: (Monthly)
Reasons for leaving: Other Benefits:
INDICATE WHY YOU QUALIFY FOR THE POST IN RELATION TO THE KPA’S DETAILED IN THE ADVERT?
Please mention any specific skills or experience that meets the requirements of the job description and person
specification. These skills may have been gained in relation to your current or previous employment, education,
training, domestic activities, voluntary work or leisure interests (Use separate sheet if necessary)
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GENERAL
Are actively involved in a leadership position within a political party? Yes No
Are any of your relatives or acquaintances employed by the Council or a Councilor? Yes No
If “Yes”, state Name, Department & Relationship:
When can you assume duty?
Do you have contractual obligation towards your present employer? If so, furnish particulars:
Have you ever been: Convicted of a criminal offence? Yes No
Is a criminal case pending against you? Yes No
Dismissed from employment? Yes No
Have you ever terminated your employment after receiving a notice of misconduct? Yes No
If yes in any of the above, state particulars on a separate sheet
Do you have any business interests? If Yes, please list these Yes No
State particulars concerning your health and ability to perform the specific work which you think Council should be
aware of.
FOR INFORMATION
Any person canvassing with a view to being appointed to a post in the council’s service shall not be considered
for appointment and will be disqualified.
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DECLARATION
I declare that the above particulars are to the best of my knowledge true and correct and I understand and accept that
if I am appointed, my appointment will be subject to the provisions of the Conditions of Service and the policies of the
Council and any other applicable legislation. I further understand and agree that any false or material
misrepresentation in my application will disqualify me from consideration for appointment, or where so appointed,
will result in disciplinary steps which could lead to my dismissal. I also understand that in addition to such
disciplinary steps, the Municipality reserves the right to take other legal steps against me including the institution of
criminal and civil proceedings.
Signature of Applicant Date:
Please note that your application will not be considered if all the information is not inserted in the areas provided
Was this form completed by yourself: Yes No
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