CanyonCoal ApplicationForm Internship
CanyonCoal ApplicationForm Internship
Please write clearly in block capitals and read the accompanying directing letter carefully before completing the form
and ensure that all sections and questions are fully answered or filled in to prevent you from being disqualified
from the selection process
Physical Address:
Ward: ___________________________________________________________________________
House/unit/Flat no. and complex/street name: ___________________________________________
Suburb: _________________________________________________________________________
City/Town: _________________________________Province: ______________________________
Is this an urban or rural area? __________________Postal Code: _______
Name nearest Town or City: _____________________________________
Contact details:
Telephone (home): ________________ (work):________________Cell: ______________________
Postal Address (if different from physical address where correspondence should be sent:
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Do you suffer from any chronic/physical handicap? ______________________________________
If yes, please provide brief details of condition: __________________________________________
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SECTION B- ACADEMIC ACHIEVEMENT DETAILS
Please attach a certified copy of your Grade 12 and tertiary academic results.
To be completed by the parent / guardian/s or persons/s on whom the applicant is dependent for
financial support or assistance by clearly stating the relationship to the applicant.
NOTE: That this application will not be considered unless this declaration has been fully
completed, sworn to and signed in the presence of a Commissioner of Oaths (e.g. minister of
religion, postmaster, senior police officer, etc).
*Only fill in the financial supporter’s details if you do not have an independent source of income*
Financial supporter’s relationship to student: ____________ Age: ___ Date of Birth: __yyyy/mm/dd_
Occupation of financial supporter: ___________________________________________________
Full names and address of financial supporter’s employer/own business: _____________________
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Please motivate the support of your application for an internship in terms of your academic
ability, financial need and future career plans.
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NOTE: The final selection is based on your final year-end results, which should reach us within
20 days of the results being made available to you.
I _________________________________ (print full names) declare that this information provided by
me, is to the best of my knowledge correct and true and that I have not applied or been awarded any
other internship, which would disqualify my application.
___________________________ _________yyyy/mm/dd_______
Signature of Student Date
I certify that the deponent has acknowledged that he/she knows and understands the contents of
this affidavit/ declaration, which were sworn to before me
___________________________________ _____________________________
Commissioner of Oaths (please print name) Signature
*FAILURE TO FULLY COMPLETE AND SIGN THIS APPLICATION FORM TRUTHFULLY BY ALL RELEVANT PARTIES
MAY LEAD TO YOUR DISQALIFICATION
CHECKLIST OF ITEMS TO BE INCLUDED WITH YOUR RETURNED APPLICATION FORM:
MAKE SURE THAT EVERY ITEM HAS BEEN TICKED ‘YES’ BEFORE SUBMITTING THE
APPLICATION FORM:
Please put a tick into the appropriate column for each item Yes
- The internship programme is for applicants that have completed tertiary education that would like to
obtain experience in their area of expertise within the mining industry.
GUIDELINES FOR PROOF OF INCOME
Applicants for Canyon Coal internships must attach proof of family income to the application
forms.
• Parents/guardians must attach the most recent payslip not older than six (6) months or an official
company letter confirming their income.
• Unemployed parents/guardians must attach official confirmation regarding temporary income.
• Unemployed parents/ guardians must attach official confirmation regarding temporary income.
• Copies of parents/ guardian’s identity documents should also be attached to the application form.
Pensioners