WINNIE MADIKIZELA-MANDELA
LOCAL MUNICIPALITY
APPLICATION FORM FOR EMPLOYMENT
TERMS AND CONDITIONS
1. The purpose of this form is to assist the Municipality in selecting suitable candidates for
an advertised post.
2. This form must be completed in full, accurately and legibly. All substantial information
relevant to a candidate must be provided in this form. Any additional information may be
provided on a CV.
3. Candidates shortlisted for an interview may be requested to furnish additional information
that will assist the Municipality to expedite the recruitment and selection process.
4. All information received shall be treated with strict confidentiality and will not be used for
any other purpose than to assess the suitability of the applicant.
5. This form is designed to assist the Municipality with the Recruitment, Selection and
Appointment of Staff members in terms of the Local Government: Systems Act, 2000
(Act No 32 of 200).
A. DETAILS OF THE ADVERTISED POST (as reflected on the advert)
Advertised post applying for
Source of Advert
Reference Number
Notice Service Period
B. PERSONAL DETAILS
Surname
APPLICATION FORM FOR EMPLOYMENT 1
First Names
ID/Passport Number
Race African Coloured Indian White
Gender Female Male
Do you have any disabilities Yes No
If yes, elaborate
Are you a South African citizen Yes No
If no what is your nationality
Work Permit Number (if any)
Do you hold any political office in a political party, whether in a permanent,
temporary
Or acting capacity. If yes, provide information below
Political Party: Position: Expiry date:
Do you hold a professional membership with a professional body? If yes, No
provide
Information below:
Professional Body: Membership No: Expiry Date:
C. CONTACT DETAILS
Preferred language of
communication
Telephone number during office ( )
hours:
Mobile
Number/s
Preferred method for SMS Email Post
correspondence
Postal
address
Code:
Email Address
APPLICATION FORM FOR EMPLOYMENT 2
D. QUALIFICATIONS (please elaborate on your CV)
Name of School Highest Qualification Year Obtained
Name of the institution Name of qualification NQF Level Year Obtained
E. WORK EXPERIENCE (Additional information may be provided on your CV)
Employer (starting with Position From To Reason for
With the most recent leaving
MM YY MM YY
If you previously employed in Local Government, Yes No
indicate
Whether any condition exists that prevents your re-
employment:
If yes, provide the name of
the employing municipality
F. DISCIPLINARY RECORD
Have you been dismissed for misconduct? Yes No
If yes, name of Municipality/Institution
Type of misconduct/transgression
Date of resignation/disciplinary case finalised
Award/Sanction
Did you resign from your job pending the finalisation of
the disciplinary proceedings? If yes provide details on a
separate sheet.
APPLICATION FORM FOR EMPLOYMENT 3
G. CRIMINAL RECORD
Were you convicted of a criminal offence involving financial Yes No
misconduct, fraud or corruption? If yes, provide details on
a separate sheet.
If yes, type of criminal act
Date criminal act was
finalised
Outcome/Judgement
H. REFERENCE (please elaborate on your CV)
Name of referee Relationship Tel (office Cellphone No. E-mail
hours)
I. DECLARATION
I hereby declare that all the information provided in this application and any attachments in
support thereof is to the best of my knowledge true and correct. I understand that any
misrepresentation or failure to disclose any information may lead to my disqualification or
termination of employment of contract, if appointed.
Signature: Date:
APPLICATION FORM FOR EMPLOYMENT 4
