candidate application form

Please complete the following in full detail.

FIRST NAMES
SURNAME
KNOWN AS
CURRENT JOB TITLE
REQUIRED POSITION
PREFERRED WORK LOCATION
PREPARED TO RELOCATE? Yes No
PREFERRED INDUSTRIES
PREPARED TO TRAVEL
LOCALLY
PREPARED TO WORK SHIFTS
DO YOU HAVE A RESTRAINT
OF TRADE – PLEASE GIVE
DETAILS
CONTACT NOs Mobile Work Home

EMAIL ADDRESS Personal

EMAIL ADDRESS Work
ID NUMBER Age
QUOTA WORK PERMIT
TITLE Dr/Mr/Mrs/Ms
GENDER Male Female
RACE
NATIONALITY
CITIZENSHIP
DISABILITY
MARITAL STATUS Dependants
SPOUSE/PARTNER Name Contact No

SPOUSE WORK Company name

RESIDENTIAL ADDRESS

LANGUAGE/S

DRIVER’S LICENCE YES NO

OWN A VEHICLE YES NO
NOTICE PERIOD
CURRENT SALARY/RATE CTC NET
CURRENT BENEFITS MEDICAL AID
PROVIDENT FUND
PENSION FUND
13TH CHEQUE
REQUIRED SALARY/RATE CTC NET
REQUIRED BENEFITS MEDICAL AID
PROVIDENT FUND
PENSION FUND
13TH CHEQUE
NEXT SALARY INCREASE DATE %
INTERVIEWS NOT ARRANGED LIST THE COMPANIES WHO HAVE INTERVIEWED YOU DATE
-
BY POLLOCK & ASSOCIATES
-
-
-
CAN YOU LEGALLY BE
EMPLOYED IN SOUTH
AFRICA?
 HAVE YOU EVER BEEN
CONVICTED OF A CRIME? IF
“YES” PLEASE GIVE DETAILS.
TO YOUR KNOWELEDGE
WITH REGARD TO ITC, DO
YOU HAVE ANY JUDGEMENT,
DEFAULTS OR BAD DEBTS
WRITTEN OFF
ANY SERIOUS MEDICAL
CONDITION THAT A FUTURE
EMPLOYER SHOULD BE MADE
AWARE OF
MARKETING INTELLIGENCE Pnet Executive Placements LinkedIn Head Hunted

Facebook Twitter Referral – WOM Google

Reasons for applying to Pollock &
Associates
Other Job Portals – State

OFFICE USE ONLY INTELLIGENCE CANDIDATE NUMBER CONSULTANT

declaration
I………………………………………………………………………………………… hereby certify that the information I have provided
on this Application for Employment is true and complete to the best of my knowledge. I have provided information about all of my full-
time jobs. I give Pollock & Associates authority to investigate all statements I have made on this form as may be deemed necessary for
reaching an employment decision. I authorise Pollock & Associates to obtain a credit/criminal check when requested as an inherent job
requirement by a client of Pollock & Associates.

I understand that any false or misleading information I knowingly provide on my Employment Application and in my Curriculum Vitae or
interview(s) may result in discharge and/or legal action. I understand also that if I am employed by any client (employer) of Pollock &
Associates, I am required to abide by all rules and regulations of the employer and any special agreements reached between the employer
and me.

Signature _____________________________________ Date______________________________________