® EMPLOYMENT APPLICATION

Surname First Name Other Names ID Number Tax Ref # Date

Physical Address Code Telephone Number ( H / W / C / O )

Postal Address (if different) Code Telephone Number ( H / W / C / O )

Home Email Work Email

Employment History — Begin with most recent

From Month/Year To Month/Year Company Name May we contact this company?  Yes  No Telephone
1
Company Products and Services Supervisor Name & Title Starting Job Title Ending Job Title Starting Pay Ending Pay Time in last position

Duties Reason for leaving?

2 From Month/Year To Month/Year Company Name May we contact this company?  Yes  No Telephone

Company Products and Services Supervisor Name & Title Starting Job Title Ending Job Title Starting Pay Ending Pay Time in last position

Duties Reason for leaving?

3 From Month/Year To Month/Year Company Name May we contact this company?  Yes  No Telephone

Company Products and Services Supervisor Name & Title Starting Job Title Ending Job Title Starting Pay Ending Pay Time in last position

Duties Reason for leaving?

Language Proficiency
Afrikaans  Read  Speak  Write Sepedi  Read  Speak  Write Tshivenda  Read  Speak  Write Xitsonga  Read  Speak  Write

English  Read  Speak  Write Sesotho  Read  Speak  Write Tswana  Read  Speak  Write Zulu  Read  Speak  Write

Isindebele  Read  Speak  Write Siswati  Read  Speak  Write Xhosa  Read  Speak  Write Other  Read  Speak  Write

©E S i I
Education/Training Summary
Secondary Education
Highest Secondary Qualification Establishment (Institution) Subject(s) Year Completed

_____________________________ __________________________________ ___________________________________________________________ _____________

Tertiary Education (Institution)

Establishment (Institution) From To Qualification Majors
__________________________________________ __________ _________ _____________________ __________________________________________________
__________________________________________ __________ _________ _____________________ _________________________________________________
__________________________________________ __________ _________ _____________________ __________________________________________________

Peer References (other than superiors or friends, for example, co-workers)

Name Company of Peer Position Title Business Telephone Home Telephone

Eligibility
Are you authorised to work in the RSA?  Yes  No Can you execute a Legal Contract? (Above 18 years of age)  Yes  No

Have you been convicted of a crime for which a pardon has not been granted?  Yes  No. (A conviction does not necessarily disqualify you from employment.)

APPLICANT AGREEMENT

,verification agencies

Applicant Signature _____________________________________________________ Date___________________________

HOA102016
Orientation
During my orientation with the Express Employment Professionals representative, I received the following (please initial):
Limited Duration Contract of Employment ________________________ Summary Disciplinary Code _______________________ Welcome Brochure _____________________

Sources Do Not Write in Shaded Areas — Unless Directed to Do So

How did you hear about Express?

Where have you applied in the last 3 months?

Have you ever worked for another staffing company?  Yes  No, if yes, what service(s)?

To which companies did the service(s) send you?

Have you ever been employed or refused employment by Express?  Yes  No, if yes, where?

Skills
What type(s) of jobs are you looking for?

Availability
Are you currently employed?  Yes  No Applying for:  Full Time  Part Time Are you willing to work overtime?  Yes  No

Shifts you can work:  Day Work  Night Work  Late Night Work Days you can work:  MO  TU  WE  TH  FR  SA  SU
How long are you available to work? Do you have a drivers licence?  Yes  No What transportation will you use to get to assignments?

How far are you willing to travel to work?

Salary Requirements? R ___________________ Minimum Hourly Salary? R _________________

Emergency Contact Information

Name Address Telephone

© Express Services, Inc.

For Office Use Only — Do not write in shaded areas.

EMPLOYEE NUMBER: __________________________ TECHNICAL EVALUATION RESULTS OTHER EVALUATIONS

______________________________________________
AT06RSA(08/12) ELECTRONIC ASSEMBLER _________
MECH ASSEMBLY REPAIR _________ ______________________________________________
APPEARANCE _________ ELECTRONICS TECHNICIAN _________
______________________________________________
PERSONALITY _________ ASSEMBLY INSPECTOR _________
ATTITUDE/BEHAVIOUR _________ MACHINE OPERATOR _________ ______________________________________________
INITIATIVE _________ DRAFTING _________
______________________________________________
SOLDERING _________
ELIGIBILITY DETERMINATION
OTHER _________________________________ DEGREE/CERTIFICATION
AREAS OF EXPERTISE
VERIFICATION
OFFICE SERVICES EVALUATIONS
ACCOUNTING/FINANCIAL  Yes  No Verification Date _____________
INFORMATION TECHNOLOGY DATA ENTRY (A) ____________________
ENGINEERING/MANUFACTURING/TECHNICAL PERSONALITY TEST RESULTS
SALES/MARKETING DATA ENTRY (N) ____________________ ______________________________________
OTHER _________________________________ FORM LETTER ____________________ ______________________________________
GRAMMAR/PUNC. ____________________
BASIC EVALUATION RESULTS
SPELL LAW ____________________
COMMENTS: __________________________________
BASIC SKILLS (Light Industrial) SPELL MEDICAL ____________________
MATH _________ /5 TYPING ____________________ ______________________________________________
FILING _________ /10 TYPE STAT. ____________________
COMPARISON _________ /10 TYPE LAW ____________________ ______________________________________________
RULER I _________ /3 10 KEY ____________________
______________________________________________
RULER II _________ /4 HANDWRITING ____________________
BASIC SKILLS (Office Services) SHORTHAND ____________________ ______________________________________________
MATH _________ /5 MS WORD ____________________
FILING _________ /10 ______________________________________________
EXCEL ____________________
COMPARISON _________ /10 ______________________________________________
POWERPOINT ____________________
SPELLING _________ /50
OTHER _______________________________ ______________________________________________

ACCOUNTING EVALUATIONS ______________________________________________

ACCOUNTS RECEIVABLE _________ /20
ACCOUNTS PAYABLE _________ /20 ______________________________________________
ACCOUNTING CLERK _________ /20 ______________________________________________
PAYROLL _________ /20
BOOKKEEPING _________ /50
STAFF ACCOUNTANT _________ /20

© Express Services, Inc.