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Includes declarations on marital status, dependents, family members employed at DUT, criminal convictions, dismissals, and other circumstances for the selection committee. 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Prof |  | Rev |  |  | Mr |  | Mrs |  | Ms/Miss |  |  | Other (Specify) |  |  |\n| Surname |  |  |  |  |  |  |  |  |  | Maiden name |  |  |  |  |  |  |  |  |\n| Name |  |  |  |  |  |  |  |  |  | Date of Birth |  |  |  |  |  |  |  |  |\n| Race | African |  |  |  | Coloured |  | Indian |  |  | White |  |  |  | Other (Specify) |  |  |  |  |\n| Gender*(Stats) | Male |  |  |  | Female |  |  | Id/Passport number |  |  |  |  |  |  |  |  |  |  |\n| Marital Status |  |  |  |  |  |  |  | No of dependents |  |  |  |  |  |  |  |  |  |  |\n| Citizenship |  |  |  |  |  |  |  | Work permit: (valid) |  |  |  |  |  | Yes |  |  | No |  |\n| If not South African – Do you have permanent residency |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes |  |  | No |  |\n| Driver’s license |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes |  |  | No |  |\n| Are you currently applying for another position within our organization? If yes, could you please provide more details?\u003Cbr>Vacancy :   Department:  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes |  |  | No |  |\n| Do you currently work at DUT? |  |  |  |  |  |  |  | Yes |  | No |  | Department: Position: |  |  |  |  |  |  |\n| Do you have family members or relatives employed at DUT? |  |  |  |  |  |  |  | Yes |  | No |  | Department: Position: |  |  |  |  |  |  |\n| Have you ever been convicted of a criminal offence? If yes specify |  |  |  |  |  |  |  | Yes |  | No |  | Specify |  |  |  |  |  |  |\n| Have you ever been dismissed from any employment? If yes specify |  |  |  |  |  |  |  | Yes |  | No |  | Specify |  |  |  |  |  |  |\n| Is there any other disclosure of circumstances you\u003Cbr>would like to make the Selection Committee aware of? |  |  |  |  |  |  |  | Yes |  | No |  | Specify |  |  |  |  |  |  |\n| Do you have any disability you would like to declare? |  |  |  |  |  |  |  | Yes |  | No |  | Specify |  |  |  |  |  |  |\n| Disability Status |  |  | Is the nature of your impairment |  |  |  |  | Physical, if yes specify |  |  |  | Yes |  |  | No |  | Specify |  |\n|  |  |  |  |  |  |  |  | Mental, if yes specify |  |  |  | Yes |  |  | No |  | Specify |  |\n|  |  |  |  |  |  |  |  | Combination of both, if yes specify |  |  |  | Yes |  |  | No |  | Specify |  |\n|  |  |  | Is the nature of your impairment |  |  |  |  | Temporal, if yes specify |  |  |  | Yes |  |  | No |  | Specify |  |\n|  |  |  |  |  |  |  |  | Permanent, if yes specify |  |  |  | Yes |  |  | No |  | Specify |  |\n| Is the nature of your impairment substantially limiting |  |  | Yes |  |  |  |  | No | If your impairment is substantially limiting, will you need support to perform the essential functions of your job should you be appointed? |  |  |  |  |  |  |  | Yes | No |\n| Have you ever been medically boarded, ifyes specify |  |  | Yes |  |  |  |  | No | Specify |  |  |  |  |  |  |  |  |  |\n\n\n| Qualifications and Experience\u003Cbr>Please complete this section in full. Do not complete with “Refer to CV”Qualifications will be verified during the selection and appointment process |  |  |\n| --- | --- | --- |\n| Senior Certificate/Degree/Diploma/Other qualification obtained and (Add appendix if required) | Institution | Year completed |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n\n\n| Professional Registration\u003Cbr>e.g. HPCSA Health Professional Council of South Africa |  |  |\n| --- | --- | --- |\n| Category of Registration | Registering Body | Date of Registration |\n|","cbCaihVNEci830SW","https://ap.wps.com/l/cbCaihVNEci830SW","pdf",158631,"English","# Personal Particulars\n# Qualifications and Experience\n# Professional Registration\n# Employment History\n# Publications\n# Detail of Current Conditions of Service","[{\"question\":\"What personal information does the form request?\",\"answer\":\"It requests title, name and surname, date of birth, race and gender, marital status, dependents, citizenship, work permit validity, residency (if not South African), and driver’s license status.\"},{\"question\":\"What disclosures and declarations are required?\",\"answer\":\"The form asks whether the applicant has been convicted of a criminal offence, dismissed from employment, has other disclosure of circumstances, and whether any disability is to be declared.\"},{\"question\":\"Which work and financial details must be provided?\",\"answer\":\"Applicants must provide employment history in chronological order and, under current conditions of service, include employer name, occupational title, salary, fringe benefits, minimum starting salary considerations, notice period, and earliest duty start date.\"}]","APPLICATION FOR EMPLOYMENT | PDF",1789823038]