FREE OF CHARGE

ADDRESS TO: TEL: (013) 249 7781 or 249 7229

THE MUNICIPAL MANAGER FAX: (013) 249 7196
FOR ATTENTION: HUMAN RESOURCE MANAGEMENT SERVICES web: www.stlm.gov.za
P O BOX 14
MIDDELBURG
1050 APPLICATION FOR EMPLOYMENT
CONFIDENTIAL
Please note:
 A separate application form should be completed for each post you apply for
 Incomplete or incorrect information could disqualify an applicant
 Canvassing for appointment will disqualify an applicant
 NO ORIGINAL certificates or CV’s should be attached to this form, but certified copies thereof must be attached.
 Should you not be contacted within six weeks after the closing date you should regard this application as unsuccessful.
 Only applications for advertised vacancies with reference numbers will be accepted.
 After familiarising myself with the advertised requirements, I hereby apply for the following position.

Advertised position: …….………………………………………………………….… Ref. No. : ………………………………..

Salary scale advertised R………………. /R…………………… /R……………………… /R………………….. /R…………………

Are you prepared to accept appointment on minimum notch of scale (yes) (no)
If no, indicate notch required : R………………… Earliest date on which duty can be assumed : ………………………….

INTERNAL EMPLOYEES Pay number: ………………………… Current position: …………………………………………………………………….

Employment status (indicate √) Permanent Temporary Contract

A. PERSONAL PARTICULARS

Surname: ID no:

First Names: Known as

Married Single Do you have a bank account YES NO

Postal Address: …………………………………………………………………………………………………………………………………………………………………..

…………………………………………………………………………………..…… Postal code: ………………………………….………………

Residential Address: ………………………………………………………………………………………………………………………………………………………………..

……………………………………………………………………………………… Postal code: ……………………………….…………………

Telephone numbers: Home: …………………………………..…… Work: …………………..…………………… Cell: ………………………..…………………………

E-mail address…………………………………………………………………………………………………………………………………………………………………………

Kindly furnish the name of an alternate contact person in the event of you not being available at the above telephone number:

Name: ……………………………………………………………………………….. Telephone no.: ………………………………….………………………………………..

Are you a South African citizen? Please indicate with √ YES NO

B. EMPLOYMENT EQUITY MONITORING INFORMATION

Race: Please indicate with √ African Coloured Indian White

Gender: Please indicate with √ Male Female

Health / Disability Please provide details of any physical disabilities and/or any other:
…………………………………………………………………………………………………………………………………………………………………………………..…………

…………………………………………………………………………………………………………………………………………………………………………………………..…
C. SECONDARY & TERTIARY QUALIFICATIONS
Name of School: Town: Province of school:

Highest Std/Grade Passed Date obtained

Subjects Passed

Name of Tertiary Institution(s)

Qualification obtained:

Date obtained:

Subjects passed: MAJOR OTHERS

IF YOU ARE STUDYING AT PRESENT, GIVE FULL DETAILS:

……………………………..………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………………………………………..…

APPRENTICESHIP / LEARNERSHIP / OTHER

Qualified Unqualified Please indicate with √
Trade: ……………………………………………………………………………………..………………………

Name of Institution: …………………………………………………………………………… Registration date: …………………………………………………………………..

Other qualifications obtained: ………………………………………………………………………………………………………………………………………………………….…

Are you a member of a professional association? Please indicate with √ Yes / No Please provide details:

……………………………………………………………………………………………………………………………………………………………………………………………………..

Additional courses attended:

…………………………………………………………………………………………………………………………………………………………………………………………………..…

……………………………………………………………………………………………………………………………………………………………………………………………………..

D. RECOGNITION OF PRIOR LEARNING

State clearly any relevant knowledge and skills obtained that can be linked to the requirements as advertised.

Knowledge of: Skilled in: (e.g. computers, supervision)

…………………………………………………………………………….……… …………………………………………………………………………….………

…………………………………………………………………………………… …………………………………………………………………………………….

…………………………………………………………………………………… ………………………………………………………………………………….…

E. GENERAL
Language proficiency
Please indicate with √ English Other: _______________________ Other: ____________________________
Good Fair Weak Good Fair Weak Good Fair Weak
Write
Read
Speak
Understand only

Are you in possession of a driver’s licence? Yes / No Date issued: …………………………………………………………. Type: …………………………………………

If endorsed, specify: ……………………………………………………………………………………………………………………………………………………………………………..

Are you in possession of a PDP license ? Yes / No Date issued:………………………………………………….Expiry Date……………………………………….

Have you ever been convicted of a criminal offence, which may impact on the post you are applying for? YES NO
F. WORKING EXPERIENCE / EMPLOYMENT RECORD

Yes No
Are you presently employed? Please indicate with √
Current / Last Employer Position held Nature of duties Period of service

Name: ……………………………………………………………... …………………………………… ……………………………………………………………………… From: …………………………

Address: …………………………………………………………... …………………………………… ……………………………………………………………………… To: …………………………….

……………………………………………………………………… …………………………………… ………………………………………………………………………

Reason for change:
Tel. No.: …………………………………………………………… …………………………………….. ………………………………………………………………………. …………………………………

…………………………………
Previous Employer(s) Position held Nature of duties Period of service

Name: ……………………………………………………………... …………………………………… ……………………………………………………………………… From: …………………………

Address: …………………………………………………………... …………………………………… ……………………………………………………………………… To: …………………………….

……………………………………………………………………… …………………………………… ………………………………………………………………………

Reason for change:
Tel. No.: …………………………………………………………… …………………………………….. ………………………………………………………………………. …………………………………

…………………………………

Name: ……………………………………………………………... …………………………………… ……………………………………………………………………… From: ……………………………….

Address: …………………………………………………………... …………………………………… ……………………………………………………………………… To: ………………………………….

……………………………………………………………………… …………………………………… ………………………………………………………………………

Reason for change:
Tel. No.: …………………………………………………………… …………………………………….. ………………………………………………………………………. ………………………………..……

……………………………………….

Name: ……………………………………………………………... …………………………………… ……………………………………………………………………… From: ……………………………….

Address: …………………………………………………………... …………………………………… ……………………………………………………………………… To: ………………………………….

……………………………………………………………………… …………………………………… ……………………………………………………………………… Reason for change:

………………………………..……
Tel. No.: …………………………………………………………… …………………………………….. ……………………………………………………………………….
……………………………………….
G. REFERENCES

I hereby certify that the above-mentioned information is to the best of my knowledge true and correct. I accept that, in the event of my application being successful, any information to the contrary
will lead to immediate dismissal. I have acquainted myself with the content of the main duties stated in the advertisement of the post and declare that I am fit to fulfil the duties.

I hereby give permission to the Steve Tshwete Local Municipality to contact any person at my current or previous employer(s) and/or relevant institution to obtain a detailed reference regarding my
general conduct, work performance-history, behaviour etc. With the exception of the following, who must not be contacted:

______________________________________________________________________Reason:_______________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________
I also give consent that this information together with any relevant information like findings by a medical practitioner, criminal record and any other relevant information be made available to Steve
Tshwete Local Municipality.

The following people can be contacted for reference purposes:

Name: Initials & Surname Position Institution Contact numbers

H. DECLARATION

I hereby confirm that the following people who are involved in the activities of the Steve Tshwete Local Municipality either as a Councillor or an official, is related to me.

NONE:

NAME & SURNAME RELATIONSHIP POSITION OR DESIGNATION DEPARTMENT

1. __________________________ ______________________ ___________________________ ______________________

2. __________________________ ______________________ ___________________________ _____________________

SIGNATURE: …………………………………………………………….. DATE: ……………………………………………...

NB : Please initial each page in the right hand bottom corner and sign next to each correction made by you on this form.
Council reserves the right not to proceed with an appointment for any vacant position.