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Only application to unemployed (section 18.2) Learners:
1. Learnership details:
Title of Learnership Qualification: *
2. Applicant details:
Full Names: *
Date of Birth: *
Race:
African:
Coloured:
Indian:
White:
Other:
Home Address: *
Postal Address: *
Telephone Address: *
Cell No: *
Identity number: *
Sex:
Male
Female
Do you have a disability, as a contemplated by the Employment Equity Act 55 of 1998?
(N.B: The Employment Equity Act defines a disability as a long-term or recurring physical or mental impairment which substantially limits prospects of entry into, or advancement in employment).
Yes No
Specify *
E-Mail Address: *
2.1 What language do you speak? *
2.3 Highest level of education? *
(example: Grade 7, ABET Level2, Standard 10)
2.5 Are you currently employed?
Yes No
2.2 Are you a South African citizen?
Yes No
2.4 Have you previously undertaken a learnership?
Yes No
If yes, specify title and code:
2.6 If you were unemployed before concluding this appliaction, state for how long?
3. Parent or Guardian details:
3.1 Full Names: *
3.3 Home Address: *
3.5 Telephone number: (home) *
3.7 Email Address *
3.2 Identity number: *
3.4 Postal Address:
(different from home)		 *
3.6 Telephone number: (work) *
Consent for Checks:
PLEASE NOTE:
In line with the company recruitment and selection policy all shortlisted candidates hereby agree to:
1. Undergo formal selection assessments
2. Undergo relevant medical examination, except HIV testing, for areas where it is an inherent requirement to furnish a medical fitness certificate as a job requirement
3. Provide consent for reference checking which will encompass:

a. Criminal record
b. Credit record
c. Verification of citizenship
4. Undergo formal selection assessments
Section E: Declaration:
I declare that all information I have provided is correct and complete to the best of my knowledge. I also hereby give permission to AfriSam to forward any personal information that I have provided in support of this application to its information verification suppliers in order to verify my personal credentials and records.
Date: *
I Accept: *