Application for Employment

All sections of this form are compulsory.

Welcome to the Lephalale Municipality employment application

The purpose of this form is to assist a government department in selecting a person for an advertised post.

This form may be used to identify candidates to be interviewed. You need to fill in all sections of this form completely, accurately and legibly. This will help to process your application fairly.

Use the Next button below each page to proceed, or the Back button to return to the previous step.

Who should complete this form?

Only persons wishing to apply for an advertised position in Lephalale Municipality.

Additional Information

This form requires basic information. Candidates who are selected for interviews will be requested to furnish additional certified information that may be required to make a final selection.

B. Personal Information
^{All information will be treated with the strictest
confidentiality and will not be disclosed or used for
any other purpose than to assess the suitability of a
person, except in so far as it may be required and
permitted by law. Your personal details must correspond
with the details in your ID or passport.}

Surname

Full Names

Date of Birth

Are you a South African Citizen?

If no, what is your nationality?

Residential Permit No (if not SA Citizen)

ID Number

Race

^{This information is required to enable
the department to comply with the
Employment Equity Act, 1998.}

Gender

^{This information is required to enable
the municipality to comply with the
Employment Equity Act, 1998.}

Do you have a disability?

Marital Status

Dependant Children & Age

Are you in possession of a valid driver's licence?

Any endorsements on driver's licence?

Have you been convicted or found guilty of a criminal offence (including an admission of guilt)?

^{The Executive Authority shall consider
the criminal record (s) against the
nature of the job functions in line with
internal information security and
disciplinary code.}

Do you have any pending criminal case against you?

^{The Executive Authority shall consider
the criminal record (s) against the
nature of the job functions in line with
internal information security and
disciplinary code.}

Have you ever been dismissed for misconduct from the Public Service?

^{This information will only be taken into
account if it directly relates to the
requirements of the position.}

Do you have any pending disciplinary case against you?

If your profession or occupation requires official registration, provide professional body name

If your profession or occupation requires official registration, provide registration number

Do you hold any political office in a political party, whether in a permanent, temporary or acting capacity? If yes, provide information below.

If your profession or occupation requires official registration, provide date of registration

C. Contact Details and Medium of Communication

Telephone number

Preferred language for correspondence

Preffered Method for additional correspondence?

Email Address

Postal Address

Residential Address

D. South African Official Language Proficiency

Language

Speak

Write or read

E. Formal Qualification (from highest to lowest)
^{Departments must accept certified documents that
accompany the application(s) with certification that is
up to 6 months, unless the advert prescribes a longer
period.}

Name of School/Technical College

From (MMYY)

To (MMYY)

Name of qualification obtained

NQF Level

Any other courses undertaken (Other applicable qualifications)?

F. Work Experience (Also attach a detailed CV)
^{The applicant may submit additional information
separately where the space provided is not sufficient.}

Are you employed at present?

Details of three previous employments

Employer

Post held

From (MMYY)

To (MMYY)

Main duties and reason for leaving

If you were previously employed in the Public Service, is there any condition that prevents your reappointment

G. References Give the names of three (3) people to whom reference may be made in support of your application. These should include two (2) previous employers (where applicable)

Name

Relationship to you

Telephone number

Attach supporting documents: ID, Certifications, CV, Drivers License

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.

APPLICATION FOR EMPLOYMENT

TERMS AND CONDITIONS

The purpose of this form is to assist Lephalale Local Municipality in selecting suitable candidates for an advertised position.
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 the CV.
Candidates shortlisted for interviews may be requested to furnish additional information that will assist Lephalale Local Municipality to expedite recruitment and selection processes.
All information received will be treated with strictly confidentiality and will not be used for any other purpose than to assess the suitability of the applicant.
This form is designed to assist Lephalale Local Municipality with the recruitment, selection and appointment of senior managers in terms of the Local Government: Municipal Systems Act, 2000 (Act No. 32 of 2000).

DETAILS OF THE ADVERTISED POST (as reflected in the advert)
Advertised post applying for
Reference number
Name of Municipality
Notice service period
PERSONAL DETAILS
Surname
First Names
ID or Passport Number
Race
Gender
Do you have a disability?
If yes, elaborate
Are a South African citizen?
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 any professional body? If yes, provide information below
Professional Body:	Membership Number:	Expiry date:

CONTACT DETAILS
Preferred language for correspondence?
Telephone number during office hours
Preferred method for correspondence
Email
QUALIFICATIONS (Additional information may be provided on your CV)

WORK EXPERIENCE (Additional information may be provided on your CV)

If you were previously employed in Local Government, indicate

whether any condition exists that prevents your re-employment:

REFERENCE

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 my employment contract, if appointed.
Signature:	Date: