Professional Documents
Culture Documents
P Holo 20230102
P Holo 20230102
S 81/971431
Republic of South Africa Z83 (81/971431)
Effective 01 January 2021
Position for which you are applying (as Department where the position was advertised
advertised)
WHAT IS THE PURPOSE OF THIS FORM
ADMINISTRATION CLERK GAUTENG DEPARTMENT OF HEALTH
To assist a government department in
selecting a person for an advertised post. Reference number (as stated in the advert) If you are offered the position, when can you
start OR how much notice must you serve
with your current employer?
This form may be used to identify candidates PHOLO2023/01/02
to be interviewed. You need to fill in all
sections of this form completely, accurately IMMEDIATELY
and legibly. This will help to process your
application fairly.
B. PERSONAL INFORMATION1
WHO SHOULD COMPLETE THIS FORM
Mashigo
Surname and Full names
Only persons wishing to apply for an Portia Nozizwa
advertised position in a government Identity
department. Date of Number 9 1 0 6 0 7 0 8 1 6 0 8 3
DD/MM/YY
Passport2
07/06/1991
Birth
number
ADDITIONAL INFORMATION
Race 3
African X White Coloured Indian Other
This form requires basic information. Gender 3
Female X Male
Candidates who are selected for interviews
will be requested to furnish additional certified Do you have a disability? Yes No X
information that may be required to make a
final selection. Are you a South African citizen? Yes X No
If no, what is your nationality?
SPECIAL NOTES
Do you have a valid work permit? (only if non-South African) Yes N/A No
8- Each application for employment form C. CONTACT DETAILS AND MEDIUM OF COMMUNICATIONS
must be duly signed and initialed by the
applicant. Failure to sign this form may lead Preferred language for correspondence
to disqualification of the application during
the selection process.
Method for
Post E-mail Fax Telephone
correspondence x x
portianozizwa@gmail.com
Contact details (in
terms of the above)
If you were previously employed in the Public Service, is there any condition that prevents your re-
appointment
Yes No N/A
N/A
If yes, Provide the name of the previous employing department and indicate the
nature of the condition.
G. REFERENCES
Johan Viljoen Production Manager 011 617 5000 / 079 699 1199
Jacob Maile Foreman 011 617 5000 / 074 652 6659
DECLARATION
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:
Signature: Date:
Page 2 of 2 Initial……….