Aansoekvorm SKDM 2022.05

APPLICATION FORM FOR EMPLOYMENT
CENTRAL KAROO DISTRICT MUNICIPALITY

TO BE COMPLETED FOR ALL VACANCIES
Private Bag X560 / 63 Donkin Street

BEAUFORT WEST
6970
1. The purpose of this form is to assist a municipality in selecting suitable candidates 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 may be provided on the CV.
3. Candidates shortlisted for interviews may be requested to furnished 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 the 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
Reference number/Location
Name of the Municipality
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 Yes No

work permit?
Do you hold a professional Yes No Name of Membership Number: Expiry date:
membership with any professional professional body
body?
CONTACT DETAILS
Telephone number during office hours ( )
Mobile phone number
Postal address
Code:
Email Address
Preferred language of communication
1|Page
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 qualification NQF level Year

Obtained
WORK EXPERIENCE (please elaborate on your CV)

Employer (starting with the Post held From To Reason for leaving
most recent) Month Year Month Year
DISCIPLINARY RECORD
Have you ever been dismissed for misconduct during the past (10) years? Yes No
If yes, Name of Municipality/Employer
Type of Misconduct/Transgression
Date of Resignation/Disciplinary case

finalised/Dismissal
Award/Sanction
Have you been accused of an alleged misconduct Yes No
and 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 Yes No
during the past (10) years?
If yes, type of criminal act
Date criminal case finalised
Outcome/Judgement
2|Page
REFERENCES (please elaborate on your CV)
Name of Referee Relationship Tel (office hours) Cell 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:
Reference Checking Consent & Authorization Form

Read carefully and completely before signing.
CONSENT
I have applied for employment with the Central Karoo District Municipality and have provided information
about my previous employment. My signature below authorizes my former or current employers and
references to release the contents of my employment record with their organizations and to provide any
additional information that may be necessary for my application for employment to the Central Karoo
District Municipality, whether the information is positive or negative.
I authorize the Central Karoo District Municipality to investigate all statements made in my application for
employment and to obtain any and all information concerning my former/current employment. This includes
my job performance appraisals/evaluations, salary history, disciplinary action(s) if any, and all other matters
pertaining to my employment history. I knowingly and voluntarily release all former and current employers,
references, and the Central Karoo District Municipality from any and all liability arising from their giving or
receiving information about my employment history, my academic credentials or qualifications, and my
suitability for employment with the Central Karoo District Municipality.
This form may be photocopied or reproduced as a facsimile, and these copies will be as effective as a
release or consent as the original which I sign.
Applicant Name and Surname: _________________________________________________________
Applicant Signature: __________________________ Date: _____________________________________
Aansoekvorm SKDM 2022.05/updated 16 May 2022
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APPLICATION FORM FOR EMPLOYMENT

CENTRAL KAROO DISTRICT MUNICIPALITY

Private Bag X560 / 63 Donkin Street

Do you have a valid Yes No

Highest tertiary qualification obtained:

Name of institution Name of qualification NQF level Year

WORK EXPERIENCE (please elaborate on your CV)

Date of Resignation/Disciplinary case

Date criminal case finalised

Reference Checking Consent & Authorization Form

Applicant Name and Surname: _________________________________________________________

Applicant Signature: Date: ___________

Aansoekvorm SKDM 2022.05/updated 16 May 2022

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