Hr201 2013

HR201 APPLICATION FORM FOR STAFF VACANCIES All applicants are required to submit the following information Covering letter of application. Application form see below. Full curriculum vitae no originals or copies of certificates necessary. Any other relevant information specified in the advertisement. An application which does not comply with the above requirements will be regarded as incomplete. Post applied for Ref* No* Department /Faculty Title Initials Please enter your first and last names below as they appear in your identification document or passport. First Name/s Surname Postal address Residential address Email address Work number Home number Fax number Mobile number Date of Birth Gender Citizenship ID or passport number Race for stats purposes African Asian Coloured Indian No White If yes licence code If none of the above please provide details Driver s licence Yes 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 a disability that may require special interview arrangements If Yes indicate nature of disability Have you ever worked at UCT If yes dates of employment If yes above previous department Total current earnings cost to company Optional Minimum expected monthly salary/annual package Optional Notice Period Where did you see this vacancy advertised Please indicate name of media or website Are you currently registered with a recruitment agency If yes please specify agency name Three referee names and contact details These referees may be contacted directly by UCT at any stage of the selection process Title and Name Position and Company/Institution 23 September 2013 Page 1 of 2 Contact number 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 Academic Posts In addition to the above please complete the following information If the post is advertised at more than one level please specify the level/s at which you are applying Main research areas of interest Research output Number of publications in peer-reviewed journals Other including papers accepted but yet to appear Supervision of students Number of Honours students graduated Number of Masters students graduated Number of Doctoral students graduated Teaching Experience List courses taught and the size of classes Declarations To be completed by all applicants Are there any circumstances relevant to your application of which in the interests of fair and frank disclosure you should make the selection committee aware if so salient particulars are required Are you facing have you faced or do you envisage having to face any disciplinary professional or criminal charges if so salient particulars are required Have you been found guilty of professional misconduct or a crime if so salient particulars are required Attach separate page if necessary Note The above information will be treated in the strictest confidence.