APPLICATION FOR EMPLOYMENT FORM

NEW CLICKS SA
Personal Details
Position Applied for Surname First Name/s Date of Birth Tax Reference Number Home Language Physical address Postal address Contact email address Home telephone number Emergency Contact [Next-of-kin] Name Name Cell phone number Telephone No Telephone No Registration number Internal/External Applicant Title: Mr / Mrs / Miss / Ms / Prof / Dr. Maiden Surname [if applicable] Identity Number
Copy of which is attached

Nationality / Citizenship Valid drivers license number

Professional Memberships

Education and Training Details

Last School Attended Highest Grade Passed Subjects Passed College/University Attended Qualification Completed Year of completion Subjects Passed Province Year

Please turn over to complete further information required

Employment Details (Attach CV)

Are you currently or have you previously been employed by New Clicks? Position Do you currently have any relatives employed by New Clicks? Yes: No: Yes: No: If Yes, which company in the group are you or have you worked for? Dates Employed If Yes, in which company and department are they employed?

Name of Current Employer

Position

Start Date

End Date

Reason/s for leaving Name of person we can call for reference Name of Previous Employer Position Contact Number Start Date End Date

Reason/s for leaving Name of person we can call for reference Name of Previous Employer Position Contact Number

Start Date

End Date

Reason/s for leaving Name of person we can call for reference Contact Number

Declaration by Applicant For legal requirement in terms of employment Equity Act of 1998

Gender: Male Disability: Yes

Female No

Race: Black If yes, specify nature of disability:

Coloured

Indian

White

I certify that all the information provided is true & correct & accept that any false declaration could lead to my dismissal. I hereby grant New Clicks SA permission to perform the necessary reference checks i.e. credit, criminal and qualifications. Signed :

Date :

For Office use Only Total Cost to Company Salary Car allowance Commencement Date Job Title Interviewed by [Print Name] Approved by [Print Name] Job Code Cost Code Signature Date Signature Date Nonpensionable Pensionable

HR Manager [Print Name]