Z83 Smart Editor

1. Personal Details

Surname

First Names

Initials

Identity Number

Passport Number (optional)

Date of Birth

Race

African

White

Coloured

Indian

Other

What is your nationality/citizenship?

Gender

Male

Female

Do you have a disability?

Yes

2. Contact Info

Preferred language for correspondence

Preferred Contact Method

Post

Fax

Cellphone

3. Criminal and disciplinary history

Have you been convicted or found guilty of a criminal offence(including an admission of guilt)?

Yes

Do you have any pending criminal case against you?

Yes

Have you ever been dismissed for misconduct from the Public Service?

Yes

Do you have any pending disciplinary case against you?

Yes

Have you resigned from a recent job pending any disciplinaryproceeding against you?

Yes

Have you been discharged or retired from the Public Service on grounds of Ill-health or on condition that your cannot be re-employed?

Yes

Are you conducting business with the State or are you a Director of a Public or Private company conducting business with the State?

Yes

In the event that you are employed in the Public Service, will you immediately relinquish such business interests?

Yes

Years of private sector job experience 0

Years of public sector job experience 0

If your profession or occupation requires official registration, provide date and particulars of registration

Date

Registration Number

4. The Advertised Post

Position for which you are applying (as advertised)

Department where the position was advertised

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?

5. Languages and Qualifications

Language Proficiency

Language	Speaking	Writing
IsiZulu
Sign Language
English
Afrikaans
IsiXhosa
Sesotho
Setswana
Xitsonga
Siswati
Tshivenda
Sepedi
IsiNdebele

In progress qualification (if any, institution and qualification names)

Qualifications (highest to lowest)

Name of institution

Name of qualification

Year obtained

6. Work Experience and References

Experience (include current employer)

Employer

Job Title

Reason for leaving

Year Started

Month Started

Year Ended

Month Ended

References

Name

Relationship to you

Telephone Number

Office hours

Office open

Office close

7. Declaration & Signature

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

Click here to sign on screen

Signed Date

8. Finalize

Ready to generate your PDF?

Profile Name (For saving)

Z83 Application Form