Government EntityMbombela Local Municipality
    LocationMbombela, Mpumalanga
    Centre / LocationMbombela
    Source and Applicationmbombela.gov.za

    CORPORATE SERVICES DEPARTMENT ANNEXURE B APPLICATION FORM FOR EMPLOYMENT 1. The purpose of this form is to assist a municipality in selecting suitable candidate for an advertised post. 2. 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 must be provided on the CV 3. Candidates shortlisted for interviews may be requested to furnish additional information that will assist municipalities to expedite recruitment and selection processes. 4. All information received shall be treated with strict confidentiality and shall not be used for any other purpose than to assess the suitability of the applicant. 5. This form is designed to assist municipality with the recruitment, selection and appointment of staff members in terms of the Municipal Systems Act, 2000 (Act No. 32 of 2000) DETAILS OF THE ADVERTISED POST (as reflected in the advert) Advertised post applying for Name of the Municipality Reference no Notice service period PERSONAL DETAILS Surname First Names ID or Passport Number Gender Male Female Race African White Coloured Indian Do you have a disability? Yes No If yes, elaborate Are you a South African Citizen? Yes No If not, what is your nationality? Do you have a valid work Permit? Yes No Do you hold a professional Yes No Name of professional body Membership Expiry date membership with any Number professional body? CONTACT DETAILS Telephone number during office hours ( ) Mobile phone number Postal address Code: Email Address Preferred language of communication QUALIFICATIONS (please elaborate on your CV) Highest educational qualification obtained Name of the School Highest Grade Year Obtained Highest tertiary qualification obtained Name of Institution Name of a NQF level Year Obtained qualification WORK EXPERIENCE (please elaborate on your CV) Employer (starting with the Position held From To Reason for leaving most recent) Month Year Month Year DISCIPLINARY RECORD Have you been dismissed for misconduct during the Yes No past ten (10) years? If Yes, Name of Municipality Employer Type of a Misconduct/Transgression Date of Registration/Disciplinary case finalised/Dismissal Award/sanction Have you been accused of an alleged misconduct and yes No resigned from your job pending finalisation of the disciplinary proceedings? CRIMINAL RECORD Have you been convicted of any criminal offence in a court of law during the past Yes No ten (10) years? If yes, type of criminal act Date criminal case finalised Outcome/Judgement REFERENCES (please elaborate on your CV) Name of Reference Relationship Tel (office hours) Cellphone Number Email 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:

    Source / Circular Reference

    mbombela.gov.za