HRD 1
DEPARTMENT OF CO-OPERATIVE GOVERNANCE,HUMAN SETTLEMENTS AND TRADITIONAL AFFAIRS 

APPLICATION: INTERNSHIP PROGRAMME

WHAT IS THE PURPOSE OF THIS FORM
To assist the department in selecting a person for the internship programme
This form may be used to identify candidates to be interviewed. Since all applicants cannot be interviewed, you need to fill in this form completely, accurately and legibly. This will help to process your application fairly.
WHO SHOULD COMPLETE THIS FORM
Only persons wishing to apply for an Internship in the Department. 
ADDITIONAL INFORMATION
This form requires basic information. Candidates who are selected for interviews will be requested to furnish additional certified information that may be required to make a final selection.
SPECIAL NOTES
1. All information will be treated with the strictest confidentiality and will not be disclosed or used for any other purpose than to assess the suitability of a person, except in so far as it may be required and permitted by law. Your personal details must correspond with the details on your ID or passport.
2. Passport number in the case of non-South Africans.
3. This information is required to enable the Department to comply with the Employment Equity Act, 1998.
4. This information will only be taken into account if it clearly relates to the requirements of the position.
5. Applicants with substantial qualifications or work experience must attach a CV.

A. ADVERTISED INTERNSHIP	
Position for which you are applying (as advertised)

Reference number (as stated in the advert)

B. PERSONAL INFORMATION	
Surname		
First names		
Date of birth		
Identity number2		
Race3	African 	White 	Coloured 	Indian	
Gender	Male	Female	
Do you have a disability? 3	Yes	No	
Are you a South African citizen?	Yes	No	
If no, what is your nationality?	--	
And do you have a valid work permit?	Yes	No	
Have you been convicted of a criminal offence or dismissed from employment?	Yes	No	
If your profession or occupation requires State or official registration, provide date and particulars of registration.		

C HOW DO WE CONTACT YOU	
Preferred language for correspondence?		
Telephone number during office hours		
Preferred method for correspondence	Post	E-mail	Fax	
Correspondence contact details (in terms of above)		

D. LANGUAGE PROFICIENCY—state ‘good’, ‘fair’, or ‘poor’	
	Languages (specify)	
							
Speak							
Read							
Write							

E. QUALIFICATIONS5 
	
Name of School/Technical College
	Highest qualification obtained
	Year obtained

Tertiary education (complete for each qualification you obtained)

Name of institution
	Name of qualification	Year obtained	

			

Current study (institution and qualification):	 -

F. WORK EXPERIENCE5
	
Employer (including current employer)	Post held	From	To	Reason for leaving	
		MM	YY	MM	YY		

							

							
If you were previously employed in the Public Service, indicate whether any condition exists that prevents your re-appointment.	Yes	No	
If yes, provide the name of the previous employing department		

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

			
please make sure that the following are certfied and attached
•	ID Document
•	grade 12 certificate
•	highest qualifications(national diploma/ degree)
•	cv
•	drivers licence

DECLARATION	
I declare that all the information provided including any attachment(s) is complete and correct
to the best of my knowledge. I understand that any false information supplied could lead to my
application being disqualified or my discharge if I am appointed.	
Signature:	Date: