A. THE ADVERTISED POST (All sections of this form are compulsory)

Seven (15) Student Internships requiring Work Integrated Learning (WIL) in Western Cape Department Agriculture Western Cape

B. PERSONAL INFORMATION

Your Surname and full names

Date of birth

Email

Your ID number

Your passport number

Race
—Please choose an option—AfricanWhiteColouredIndianOther

Gender
—Please choose an option—FemaleMale

Do you have a disability?
—Please choose an option—YesNo

Are you a South African citizen?
—Please choose an option—YesNo

If no, what is your nationality?

Do you have a valid work permit? (only if non-South African)?
—Please choose an option—YesNo

Have you been convicted or found guilty of a criminal offence (Including an admission of guilt)?
—Please choose an option—YesNo
If yes (provide details)?

Have you ever been dismissed for misconduct from the Public Service?
—Please choose an option—YesNo
If yes (provide details)?

Do you have any pending disciplinary case against you?
—Please choose an option—YesNo
If yes (provide details)?

Have you resigned from a recent job pending any disciplinary proceedings against you?
—Please choose an option—YesNo
If yes (please note that the provisions of the Public Service Act shall apply)?

Have you been discharged or retired with the Public Service on grounds of ill-health or on the condition that you cannot be re-employed?
—Please choose an option—YesNo

Are you conducting business with the State or are you a Director of a Public or Private company conducting business with the State?
—Please choose an option—YesNo
If yes (provide the details)?

In the event that you are employed in the Public Service, will you immediately relinquish such business interests?
—Please choose an option—YesNo

Please specify the total number of years of experience you have.
Private sector
Public sector

If your profession or occupation requires official registration, provide date and particulars of registration.
Date
Reg.No

C. CONTACT DETAILS AND MEDIUM OF COMMUNICATIONS

Preferred language for correspondence .

Method for correspondence:
—Please choose an option—PostFaxEmailTelephone
Please list your contact details and alternative contact information
Please list your Physical address and postal address

D. SOUTH AFRICAN OFFICIAL LANGUAGE PROFICIENCY – state ‘good’, ‘fair’, or ‘poor’

Please list your languages and state speak by choosing ‘good’, ‘fair’, or ‘poor’.
Afrikaans: GoodFairPoor
English: GoodFairPoor
isiXhosa: GoodFairPoor

E. FORMAL QUALIFICATIONS (from highest to the lowest)

Please list your Name of School, highest qualification Grade obtained, then Year obtained.
Province of the School:Eastern CapeFree StateGautengKwaZulu-NatalLimpopoMpumalangaNorthern CapeNorth WestWestern Cape
Name of School: Year of Qualification:
Name of highest Qualification :

Please list your Name of College/ university, then Name of Qualification obtained, then Year obtained.

Province of the School/ Technical College:Eastern CapeFree StateGautengKwaZulu-NatalLimpopoMpumalangaNorthern CapeNorth WestWestern Cape
Name of college/university and Qualification 1: Year of Qualification 1:
Name of college/university and Qualification 2: Year of Qualification 2:
Name of college/university and Qualification 3: Year of Qualification 3:

F. WORK EXPERIENCE (Also attach a detailed CV)

Please list your Employer (including current employer), then Post held, the From/To and lastly Reason for leaving. (In this order)
[textarea *list-employer]
If you were previously employed in the Public Service, is there any condition that prevents your reappointment.
—Please choose an option—YesNo
If yes, Provide the name of the previous employing department and indicate the nature of the condition.

G. REFERENCES

Please list your reference Name, Relationship to you and Tel. No. (office hours). (In this order)
Reference 1
Reference 2
Reference 3

Please upload your ID, CV, Qualifications. Application must be accompanied by a letter from the institution of higher learning indicating the required WIL period.

Upload files (8mb limit total, only images, pdf, doc or docx files accepted)
Upload ID document (3mb max):
Upload CV document:
Upload Qualifications:
Upload letter from institution of higher education (WIL period):

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:
I accept the terms of this form as stated.

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