SOUTH AFRICAN.

POLICE SERV]CE

APPLICATION FOR APPOINTMENT IN AN ADVERTISED POST

fittsLEtF
\ttj:rt :- \iill,r:ril

Post for which you are ailp|v g (as it wa3:,edv

,

ffip-tu,,,,,iixx
BER I".TIAT wlLL BE REGISTERED)

DtD you,'AppLy FoR ANy orHER pos:tilN,,rHts ADVERTTSEMENT?

!t
 PLEASE ATTEND TO THE FOLLOWING IMPORTANT DIREETIVES:
The application form must be completed in your own handwriting. All instructions on the application
form must be adhered to. Failure to do so may result in the application being turned down.
An original application forrn and CV must be submitted. Copies will not be accepted.
This form must be sworned to or affirmed and then be signed in the presence of a Commissioner of
Oath.
The CV must contain full particulars of all boards on which an applicant serves, remunerated
outside the public service, career promotions/appointments, career developments, career history,
current studies and qualifir;attons.
Certified copies of an applicant's lD document, motor vehicle driver's licence, all educational
qualifications obtained and service certificates of previous employers stating the post occupied,
must also be submitted and be attached to every application.
Verification of qualifications will be done and the appointment will be subjected to confirmation of the
qualifications.
Applicants will be subjected, to a vetting process which will inclUdeiseculily screening and fingerprint
verification
{pplications must be mailed timeously, prior to the due date. Late applications will:ihot *be accepted
or considered. Applications that do not meet these requiremen.ls:will not\pe c'o'hsid$,5ed.
Correspondence may "J -- - conducted
be - --: with successful,eahdidates
r': i
only.
onlv.
/riii:t"i:i:'
;::ri
laliri'
i ::

Short-listed candidates witl'lbe interviewed only on the dafE ar;1$;:'fime specified by the relevant

ln filling the above post, an applicant whose appointrn6ht:rivilf:.p[on]ote':representivity may receive

r'mbntioned in the advertisement.

'' r (MAtt
THE DUE DATE.IN SOME INSTANCES POSTAL

SEND IT TO OUR DOOR ADDRESS.

PERSONAL INFORMATION
,/\/\/\,!\,^

PERSAL/ FORCE NUMBER (currently in SAPfi, SANDF or another Public Service Department)

SURNAME lALt"t I t:- L

FIRST NAMES
'iLttri6 t..
IDENTITY NUMBER
'l,1 lLr l'i l'i
u I
j lr lrrlJl:s
DATE.FBTRTH . lilq ltr Jl'i lr I AGE J(
RANK (SAPS or sANDF) V,,St'l tl, | ,,r.. frt)i, trrt t'sTt'ti 1 i u c: ( tt ttl
ARE you A sourH AFRTcAN crrzEN? | ves N NO

POSTAL ADDRESS WORKADDRESS

lletu tr,i r ,i n , { l'fi r, rtr

Page 2
 ft"*t h

AL STATUS

HIGHEST GRADE PASSED IN SCHOOL (PLEIiSE MARK WITH AN X):

r
BELOW GRADE 1O

r. Cp^rr"M ifq y'r4,'i _) 2. P',*, t4 l)tnitn,lJ"u/"i,1

r:,/.t/\-t"\-A..//
DRIVER'S LICEN5E )\
Code (as it is
appearing on the
licence card)

M@i

LANGUAGE

AREI YOU PHYSJQAttYi DISAB-LED? (SPECIFII)

HEALTH
l.-r,,v.rr^-"vl.l-^-

pllySICflLLy : :,,..,:..:.::,rr,:,tiii:i vEsx NO YEfi NO

Page 3
 PNET IOUS TERMINATION OF SERVICE (DISCHAR6E)
\,^/ \/\/\/\/\,A,\/\,^,^/\r\, ,^Z\,^v\/v'v^wa\,"J\/\/\

!.lY.i,Y?q,I,,qEFYlq'i',lT',Y?YitI'l1![1:1ylI1'E?1,
!F YES: SPECTFY THE.FOLLO.WING.REASOI'I (SELEGT :QNE.WTH.AN X):
-,- I
YES
l.l-

RETRENCHMENT I IvIIscoNoucT I IueoIcRL UNFITNESS I SEVERANCE PACKAGE I VOLUNTARY RESIGNATION

DATE OF.TERMINATION: {i\S 1i:r:::::i::.

IN.INSIANQE,QF VOLUNTARTLY RESIGNAT!OI,};: WAS THERE A DISCIPLINARY

"*,t -"
YES | *oX , o;

EtvlPL0YERr

linl. ( CONFLICT OF INTEREST

,t t:n,/\/\//\/^\.\ffi,v
ii ANE VOU.IUVOTVED IN ANYOUTSIDE BUSINESS OR ACTIVITIES, OR DO YOU HAVE ANY INTERESTS WHICH.MAY.'cQNFLICT OR ARE
*i r LIKETY''TO ,C€NFLlgT,WtTH ,THE EXECUflC,ry OF ANY,OFFIOTAL DUTTES, SL,tOULD YOU BE THE SUCCESSFU!,CANDID,AT-E FOR THIS
ii POST?
l|i
ql
t1
NO

EVER.BEEN DECLARED

CRIMININAL / OFFENCES
\,^\//\/^\i4\4!iar,}.1\aiEse\,^
HAVE YOU EV.EE.BEEN.FOUND GUILTY OF A CRIMINAL OFFENCE? NO

YES NO

X
HAVE YOU EVER tsEEN REFEREEDT.TO,AIF$YCHIARIC:HOSPITAL lN TERMS OF SECTION,TT(6) YES NO
ii /OR FOUND NOT TO HAVE HAD TIIE NECESSNRV CNIN,NINEL CAPACITY AND REFERRED fO A
E, FSY0FiIATRICTFIO$IpITALINTERMSOF:$EliIlON:7.8-{6)O}'?HE'CRIMINALPROCEDUREACT?
YHS, PARTICULAR$ MUST BE ATTACHEN.
lF
X
IF YES. SPECIFY THE FOLLOWING:

CASE NUMBER: NAME oF POLICE STATION cAS..... ./MONTH..........^rEAR

'JFFENCE:'(e.o. assault)1
, : r":ii. .r,",r , .li: -:' i:
,SENTENCE IMPO€ED (MARK:QNE WITH AN.X):

IMPRISONMENT SUSPENDED ADMISSION,OF,GUILT

r.:
PERIOD: FROM .....,............... ... .. .(DATE)
PERIOD:......... ...., (eg 2 years)
AMOUNT: R..........
a
:l TO...... ........... (DATE)

IF YES,

Mi$Oei-NDiicv;,{es,Apaphe&SiihsiI-Udi, r:

SANCTION IMPOSED;

Igl_lral_ X: f:,1- _-- - pase4

IS THERE ANY CRIMINAI-, CIVIL OR DISCIPLINARY ACTIO}.I PENPING.AGAINST YOU?

iF,:,YEsi6EEe,lefj

AP PO I NTM E NT/P R Cr\.1 OTI O N S

rrfa; X-U Page 5

 (, ir [;'L:c1r ](-.r

Car)h\rfr
H
{i tl; n,1
lt
\.,5.-1-' (.r-t1 tfutr ii,
tt-

1
,)
-i r:i:lii.
\ii:::Lr,.
n .ri:
'.
lll':1 -':':r''lrrf' ,

'ii!:r"
rii:,:, .r:i:.:::liJ
r:*r..,.{:::l!
l:"\'

,, ,i '
rlcutA RS OFI lVr f,Rr
r.rerue, L
tr-rHr$ {[-.r.:
)l ADDRtrSS Atr A^[,D I
tt l ,lFI,t, ^n

i i, /' -.L.. , r - /'/

yr U4DUi)(, ADDRESS OF COMPANY:(-l ,- t,,t ._.
,ll
_.-#tt
f;l
rl ic,r^'l;rr,tit ".It;1:.,liy,:11,
Jtt.,tt kt,t 11r,, l
tlJtrg_

PosrAL coDE '1,i1:

"t
il
E-MAIL
airl(f qll
t b :)
E.MAIL
ln6Wj
Tel, WORK
0ll :) () 1 ) () 1 /
FAX
1 ) Tel. WORK

FAX
t) Lt I A
rJ (') I tt L1
I
CELLPHONE rll ii ?
Lt It 7
/1
I ,l
I CELLPHONE
a l-7
r)
(l
,}
/ ) r'.
,) q
1 b 5
Ir
lr

I hereby apply for an, appoint ttent to a post in the south African poilce service.
that no p,.orlr"u have been
I realise that there are a
[TllTi]xfr";:[j""lt:J,:: ,rJ"1o me about an alpointment or posting in the

After.attestation/appointment in the south

African Police service, t shalt perform my crutie.s as an employee of
f
nlt1al1X:"r
Page 6
 i994. as applt)aDle. i Sfio:/ Srsc ODey any tAi,Tt, C;cE( c' ,'tst,'-1.:i -is-el - .s'-s i- -- '=:-
=:2 =

I realise that -
li
3.1 The National Commissioner is under no obligation to fill an adveftised post',
3.2 I may have to submit mysetf to any medical or other fesfs fhaf are an inherent requirement for the post, and
that may be required to finalise my application for an appointment,
I have to provide futt particular:.; about my obligations to employers and debts if my application receives fufther
consideration,
3.4 The South African Police Seivrl:e will verify my residential address and qualificafions as well as citizenship.
?6 Reference checks will be conducted on all short listed applicants
J.O lf my application does not meet the requiremenfs sef out in the advertisement, my application will be turned
down',
3.7 I rnay be subjected to a security clearance; and
3.8 lnterviews with short-tisted applicants will take place on the date, time .a.q$i\.iffi.ce determined by the
interuiewing panel.
3.9 For appointment in a post which forms paft of ceftain identified cate:gjories, l,;y1.ill ,bEisubiected to a vetting
process in terms of the prescrip,B o1 the Sexual Offences Act, 2007 (Act no 32. of 20iA7) and lhe Children's AcL
2005 (Act no 38 of 2005). lf my nsps appears on either one of the natipnal'regtsters:t{jt-g...3.fipointment will not
be considered and deemed as null and void. ':.i: ''r{r!:liir"" .
4. t certify that the information st:pptied by me on this *app'tication/statemeii'was made in my own handwriting
words and that O ,t ,n u,,,*rrr",pects correct and true. ; .
. l

,ti,::,,:,:.
* Delete which is not applicabte and iniliatand date. ii\1i$'
'1-
", ..rS$l
1:,s.,'

\\s
f, I know and understand the contgpt of this statement (5liF-lication form).

A I have (no) objection(s) to taking ine prescrined oath.

,E I (do not) consider the prescribeO o5thtfue biiitlng,afiimy conscience.

i

EI'.F
li

'J
PLAC: ..ft.t:.:t b..tf

t
cerlify that the aeponen'ifu acknctwit;,dged that he/she knows and understands the content of this statement which
:ll
ll was sworn to/affirmed beford'"me and the deponent's signature was placed thereon in my presence.

u1
i' CN THE...... DAY OF. (year) 20........... AT

PLACE:

SIGNATURE OF COMMISSIONER OF OATHS

l
li
Ei
fi