G.P.

S 81/971431
Republic of South Africa Z83 (81/971431)
Effective 01 January 2021

APPLICATION FOR EMPLOYMENT

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

Position for which you are applying (as Department where the position was advertised
advertised) DEPARTMENT OF
WHAT IS THE PURPOSE OF THIS FORM
ADMINISTRATION CLERK CORRECTIONAL SERVICE
To assist a government department in
selecting a person for an advertised post. 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?
This form may be used to identify candidates (Ref: HO 2024/08/01) IMMEDIATELY
to be interviewed. You need to fill in all
sections of this form completely, accurately
and legibly. This will help to process your
application fairly.

B. PERSONAL INFORMATION1
WHO SHOULD COMPLETE THIS FORM
THABA
Surname and Full names
Only persons wishing to apply for an KGOTHATSO COMFORT
advertised position in a government Identity
department.
Date of Number 8 6 2 6 0 3 5 2 0 8 5
8a 0case
Birth 26/06/1988
DD/MM/YY
Passport2
number
N/A
ADDITIONAL INFORMATION
Race3 African White Coloured Indian Other
This form requires basic information. 3
Gender Female Male
Candidates who are selected for interviews
will be requested to furnish additional certified Do you have a disability? Yes No
information that may be required to make a
final selection. Are you a South African citizen? Yes No

SPECIAL NOTES
If no, what is your nationality? N/A
Do you have a valid work permit? (only if non-South African) Yes N/A No
Have you been convicted or found guilty of a criminal offence Yes No
1 – All information will be treated with the (including an admission of guilt)? 5
strictest confidentiality and will not be
If yes (provide the details)
disclosed or used for any other purpose than
to assess the suitability of a person, except in
Yes No
Do you have any pending criminal case against you?
so far as it may be required and permitted by If yes, (provide the details)5
law. Your personal details must correspond
with the details in your ID or passport. Have you ever been dismissed for misconduct from the Public Yes No
Service?4
2 – Passport number in the case of non- If yes (provide the details)6
South Africans.
Yes No
Do you have any pending disciplinary case against you?
3 – This information is required to enable the If yes, (provide the details)
department to comply with the Employment
Equity Act, 1998. Have you resigned from a recent job pending any disciplinary Yes No
proceeding against you? 4
4 – This information will only be taken into If yes, (please note that the provisions of the Public Service
account if it directly relates to the Act shall apply).
requirements of the position.
Have you been discharged or retired from the Public Service Yes No
on grounds of Ill-health or on condition that your cannot be re-
5- The Executive Authority shall consider the
employed?4
criminal record (s) against the nature of the
job functions in line with internal information
Are you conducting business with the State or are you a Yes No
security and disciplinary code.
Director of a Public or Private company conducting business
with the State?6 If yes, (provide the details)6
6- The applicant may submit additional
information separately where the space Yes No
In the event that you are employed in the Public Service, will
provided is not sufficient. you immediately relinquish such business interests? N/A
7- Departments must accept certified Private Public Sector
Please specify the total number of years of experience you Sector
documents that accompany the
have
application(s) with certification that is up 1.8 0
to 6 months, unless the advert prescribes If your profession or occupation requires official registration, Date Reg. No
a longer period. provide date and particulars of registration
N/A

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 Z83 (81/971431)

8- Each application for employment form

C. CONTACT DETAILS AND MEDIUM OF COMMUNICATIONS
must be duly signed and initialed by the
applicant. Failure to sign this form may lead Preferred language for correspondence
to disqualification of the application during ENGLISH
the selection process.
Method for
Post E-mail Fax Tel
correspondence
Contact details (in
terms of the above)
0726883200 OR
O721897987

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

Languages (specify)
ENGLISH SEPEDI ISZULU
Speak
GOOD GOOD GOOD
Write or read GOOD GOOD FAIR

E. FORMAL QUALIFICATION7 (from highest to the lowest)

Name of School/Technical College Name of qualification obtained Year obtained

TSHWANE NORTH TVET COLLEGE N6 PUBLIC MANAGEMENT 2022

FUTURE TRAINING COLLEGE HEALTHCARE WORKER 2018
STANZA BAPAPE COMMUNITY SKILL MICROSOFT OFFICE 2016
RENEILWE ABET CENTRE GRADE12 2014
Current study (institution and qualification):
N/A

F. WORK EXPERIENCE (Also attach a detailed CV)6

Employer (including current Post held From To Reason for leaving
employer)
MM YY MM YY
BULA-DIKGORO.P.SCHOOL ADMIN CLERK 01 2024 TO DATE/PRESENT
CARE WORKER
KROLENDAL AGEHOME 04 2018 01 2020 END OF CONTRACT

If you were previously employed in the Public Service, is there any condition that prevents your re-
Yes No
appointment
If yes, Provide the name of the previous employing department and indicate the
nature of the condition. N/A

G. REFERENCES

Name Relationship to you Tel. No. (office hours)

L.M MANTANA PRINCIPAL(BULA-DIKGORO) 012 8158010/ 0839451664

F.MASOMBUKA ADMINISTRATION CLERK 0128158010/ 0729707277
CLEMENTINE MAHLAKE ADMINISTRATION CLERK 0128158010/ 0761642838

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:
Verified by pdfFiller

Signature: KCthaba 09/23/2024

Date:
23/09/2024

K.C
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 Kgothatso Comfort Thaba
27735 Mashiloane Street Mamelodi East P.O Box 0122
0726883200 | [email protected]

Objective

I am currently volunteering as an Assistant Administration clerk and holding N6 in Public Management. I am

seeking for a role which allows me to continue learning and perfecting my skills as I provide high-quality work and
encourages me to flourish as Administrative officer

Experience

Bula-dikgoro 09/01/2024 - Currently volunteering

Assistant Administration clerk
Excellence in data entry and database administration by transitioning from paper-based process to
automated systems.
Demonstration of exceptional customer service.
Maintain a leave register.
Submission of documents.
Assisting with the print out and making copies.

Education

Tshwane north tvet college 2022

Public Management
N6

Stanza Bopape Community Leadership 2016

Computer skills
Microsoft office

Reneilwe ABET Centre 2014

Grade 12

Skills

Customer service, Team work, Time management, Multitasking

Personal Details

Date of Birth : 26/06/1988

Gender : Female
Driving Licence : C10

Reference

Mantana L.M - Bula-dikgoro Primary School

Principal
[email protected]
0128158010

Masombuka. F. - Bula-dikgoro Primary School

Administration clerk
[email protected]
0128158010/0729707277

Clementine Mahlake - Bula-dikgoro Primary School

Finance administration clerk
[email protected]
0761642838/0128158010