Gcobisa

HR (R2) |FOR OFFICIAL USE | | | | | |1. Date Received: . . . . . . . . . . . . . |2. Date Acknowledged: . . . . . . . . . . . . . .|3. Reply sent on: . . . . . . . . . . . . . .| |. . . . |. . . |. . . | APPLICATION FOR EMPLOYMENT (For all posts) NOTE: Applicants to note the General Notice circulated separately and the following: (a) This form must be completed legibly by the applicant (PLEASE PRINT OR TYPE ALL INFORMATION EXCEPT SIGNATURE (b) A separate application form must be used for each vacancy. (c) Clear certified copies of all educational certificates, certificates of character and service certificates for all periods of service stated on this form, must be attached. (d) Successful applicants will be required to produce ORIGINAL documents, including Book of life, certificates of services, character and educational qualifications for certification purposes and a medical certificate at own cost . (e) Documents submitted with applications, including curriculum vitae, will not be returned. (f) Incomplete or late applications will not be considered. (g) Any false statement made will render a successful candidate to immediate dismissal or disqualification of the application. (h) Applicants must meet the minimum requirement/s indicated in the advertisement before lodging an application. (i) This University reserves the right to verify the authenticity of all documents submitted, e.g. BA degree, etc | | |A. POST APPLIED FOR : | |1. Designation of Post : | | |2. Ref No. | | |3. Department : | | |4. Permanent, Temporary, Contract : | | |5. If responding to a composite or consolidated advertisement, indicate which other post/s you have applied for (if applicable) | |(i) (ii) (iii) | |B. PERSONAL PARTICULARS | |1. (i) Surname : | |Title:| | |(ii) First Name (s) : | | |(iii) Maiden Name : | |(iv) Identity Number : | | |(v) State whether South African citizen |YES | |NO | | |If not a South African citizen - Have you a permanent residence permit |YES | |NO | | |(vi) Nationality : | | |2. (i) *Gender (For statistical purposes) : |Male | |Female | | |(ii) *Race (For Statistical purpose) : African | |Coloured | |Indian | |White | | |Other | |Specify | | | |* Please tick whichever is applicable | |3 (i) Business Address: | | |Code: | | |(ii) Residence Address: | | |Code: | | |Please indicate which address is preferred for postal purpose : | | |4. Telephone : Business: Code : | |No : | | |Residence: Code : | |No : | | |Telefax : | |Cell : | |E- Mail :| | |5. Date and Place of birth: | |6. Marital Status | | | | |: | | |7. Children Number : | |Ages : | | |8. Have you any physical or mental defect or disease |YES | |NO | | |If “Yes' describe | | | | | |State health condition: | | | | |9. Have you ever been medically boarded, if yes specify |YES | |NO | | |10. Have you ever been: (i) Convicted of a criminal offence' |YES | |NO | | |(ii) Dismissed from any employment' |YES | |NO | | |If “Yes” to (i) or (ii), state reason (s) : | | | | | |C. PRESENT EMPLOYMENT | |1. Name and Address of present Employer : | | |Code |: | |2. Date of appointment : | |Position held :| | |3. Salary Scale : | | |4. Present Annual Earnings (Excluding allowances) : (Please attached most recent salary advice) | | | |D. DRIVER’S LICENCE | |DATE OF ISSUE |CODE |LICENCE NO. |LICENCE ENDORSED (Yes / No) | |1. | | | | |2. | | | | | | | | | |E. LANGUAGE PROFICIENCY | |PROFICIENCY IN LANGUAGES |SPEAK |READ |WRITE |HIGHEST EXAMINATION PASSED | |1. English | | | | | |2. Zulu | | | | | |3. Other (Indicate) | | | | | | | |F. QUALIFICATIONS This section must be completed | |NOTE : Certified copies of all educational certificates must be submitted (Note (c) on page 1 refers). If not indicated on certificate/s, | |list/s of all subject credits must be furnished. | |EDUCATIONAL QUALIFICATIONS |INSTITUTION |QUALIFICATIONS |MAJOR SUBJECTS (where applicable) |YEAR OF | | | | | |COMPLETION | |(1) Secondary /High School | | | | | |(2) Academic (eg. BA) | | | | | |(3) Professional (Teaching & Other) | | | | | |(4) Technical | | | | | | | | | | | |G. MEMBERSHIP OF PROFESSIONAL BODIES, IF APPLICABLE | |INSTITUTION / SOCIETY |COMMENCEMENT YEAR |TYPE OF MEMBERSHIP | | | |eg. Associate /Fellow | | | | | | | | | | | | | | | | | | | |H. DETAILS OF RESEARCH PROJECTS UNDERTAKEN / SCIENTIFIC PUBLICATIONS / PAPERS PRESENTED - IF APPLICABLE | |(Other than that for degree/diploma purposes - Use a separate sheet if necessary) | | | | | | | | | | | | | | | | | | | | | | | |I. EMPLOYMENT HISTORY : Note: If applicable, this section must be completed in chronological order, notwithstanding submission of curriculum | |vitae/separate list with details. Refer to (Note (f) on page 1 | |NAME OF EMPLOYER |POSITION HELD |EXACT DATES |TOTAL |REASON FOR LEAVING | | | |FROM |TO | | | | | |1. Tertiary Lecturing experience - years | | |2. Other Lecturing experience - years | | |3. Administrative experience - years | | |4. Other experience - years | | |Give, as concisely as possible, details of your relevant experience in respect of the position applied for . (if considered necessary, attach| |a separate statement setting out information in greater detail) | | | | | | | | | |J. SCHOLARSHIPS, BURSARIES, FELLOWSHIPS AND OTHER AWARDS | |NATURE OF AWARD |DATE AWARDED | | | | | | | | | | | | | | | | | | | |K. DETAILS OF PRESENT STUDIES | |1. Course of Study : | | |2. Subjects/modules already passed : . | | |3. Subjects/modules still to be passed : | | |4. State when final examinations will be written/ course will be completed |. | | | |L. GENERAL | |1. Period of notice required by present employer : | | |2. Earliest date able to commence duty, if successful : | | |3. Interest (e.g. sporting, social, cultural) | | | | |M. COMPUTER LITERACY | |Indicate experience and /or qualifications | | | | | | | | | | | | | | | | | |N. REFEREES: Indicate details of 3 persons who may be approached for information on your personal qualities and suitability for the post. | |Please ensure that complete particulars are furnished. | |Referees will be contacted prior to finalisation of appointment | |NAME |POSITION |Postal Address and Code |Code and Tel. No/ | | |(If applicable) | |Email/Fax No | |1. | | |Tel | | | | | |Email | | | | | |Fax | | |2. | | |Tel | | | | | |Email | | | | | |Fax | | |3. | | |Tel | | | | | |Email | | | | | |Fax | | | | | | |O. Where did you read or hear about the vacancy' | | | |P. Do you have any family members or relative employed at this University' |YES | |NO | | |If so, state names, departments and how related | | | | | | | | | |Q. FINANCIAL/ CONTRACTUAL OBLIGATIONS WITH PRESENT EMPLOYER eg. BURSARIES, SCHOLARSHIP, LOANS, ETC. | |1. | |2. | |3. | |4. | | | |R. CERTIFICATION AND ACKNOWLEDGMENT | |I, the undersigned, hereby certify that all the information furnished on this application form is correct and accept that the furnishing of | |any false information or the withholding of relevant or material information will render me liable to disqualification or dismissal, if | |appointed. | | | | | | | | | | | | | |. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | |. . . . . . . . . SIGNATURE OF APPLICANT DATE | ----------------------- 41/43 Centenary Road, Durban, 4001 P O Box 1334, Durban, South Africa, 4000 Tel : +27(31)3732000 Website : www.dut.ac.za DS@DUT:corp/HR-Sept.08:ip