AMATHOLE DISTRICT MUNICIPALITY
Municipal Manager
15 Rees Street, Quigney, East London, 5201
P.O. Box 320 * East London *South Africa * 5200
Telephone: 043 701 4000 * Facsimile: 043 721 2478
Email: [email protected] * Web Address: www.amathole.gov.za
APPLICATION FORM FOR VACANCIES
All applicants are required to submit the following information:
• Application form (see below). Ref: 4/3/R
• Full curriculum vitae.
• 6 months stamped certified copies of all relevant academic certificates including the ID
• Any other relevant information specified in the advertisement.
An application that does not comply with the above requirements will be regarded as incomplete.
Post applying for and
Post Identification Number
Title Initials
Please enter your first and last names below as they appear in your identification document or passport.
First Name/s
Surname
Maid Maiden surname (if applicable)
Postal address
Residential address
Email address
Work Number Home number
Fax Number Mobile number
Date of Birth Gender
Place of Birth
Nationality
ID or passport number
Race (for stats purposes) African Asian Coloured Indian White
If none of the above, please provide details
Driver’s Licence If yes, licence code
If RSA permanent resident, please indicate date obtained
In possession of a Work Permit? (If yes, please provide a
copy of your current permit with your application)
If invited for interview, would you require a visa?
Do you have disability?
If yes please indicate your disability
Summary of Qualifications and Experience
Note: Please enter your qualifications and employment history information in this section as well as on your CV.
Qualifications (All qualifications are verified prior to appointment)
School certificate /Degree/Diploma /Other qualification obtained Institution Year
Employment History (Please list the most recent first)
Position Company/Institution Dates of employment Reason for leaving
From To
MM YY MM YY
Proficiency in Languages Speak Read Write
IsiXhosa
English
Isizulu
Other (Specify
Declarations (To be completed by all applicants)
Note: The above information will be treated in the strictest confidence. Criminal checks (via fingerprint
process) are conducted for all successful candidates, with their prior permission.
Are there any circumstances relevant to your application of which, in the interests of Yes No
fair and frank disclosure, you should make the selection committee aware? (if so, salient Attach separate page if necessary
particulars are required)
Are you facing, have you faced, or do you envisage having to face any disciplinary Yes No
(professional or criminal charges)? (If so, salient particulars are required) Attach separate page if necessary
Have you been found guilty of professional misconduct or a crime? (if so, salient Yes No
particulars are required) Attach separate page if necessary
Have you ever been convicted of a criminal offence or been dismissed from Yes No
employment (if so, salient particulars are required) Attach separate page if necessary
`Three referee names and contact details
(These referees may be contacted directly by ADM at any stage of the selection process)
Title and Surname Position and Company/Institution Email address Contact number
I declare that all the information provided is complete and correct
Name Date
Signature
