Candidate Application Form & Kroll

OUR SERVICE DOESNT STOP AFTER PLACEMENT, IT STARTS
Thank you for approaching Assignments on Contract (PTY) LTD to assist you in finding suitable employment. Please complete the attached questionnaire. This Questionnaire is to facilitate the process of placing you in a suitable vacancy, should one arise. This is not an application for employment.
PERSONAL / CONTACT DETAILS
INTERVIEW DATE SURNAME FIRST NAME
MR/MRS/MS KNOWN NAME
IDENTITY NUMBER
PERSONAL EMAIL ADDRESS WORK EMAIL ADDRESS
TEL NO HOME ALTERNATIVE CONTACT PERSON
WORK
CELL TEL
POSTAL ADDRESS CODE
PHYSICAL ADDRESS CODE
AVAILABILITY
IMMEDIATELY
YES
NO
NOTICE PERIOD (Kindly Indicate)
LAST POSITION HELD
PROFESSION
FOR OFFICE USE ONLY CONSULTANT NOTES AUDIT BOOKKEEPER FINANCIAL MANAGER FINANCIAL CLERK OTHER
ENTRY LEVEL PAYROLL/HR CA IT
DEBTORS/CREDITORS/CASHBOOK ACCOUNTANT COST & MANAGEMENT ACC ENGINEERING
ASSIGNMENTS ON CONTRACT (PTY) LTD |
LANGUAGES HOME LANGUAGE OTHER LANGUAGES 1. 2. 3. 4. 5.
READ READ READ READ READ
WRITE WRITE WRITE WRITE WRITE
SPEAK SPEAK SPEAK SPEAK SPEAK
WOULD YOU CONSIDER UNDERTAKING TEMPORARY ASSIGNMENTS?
YES
NO
ARE YOU SOUTH AFRICAN CITIZEN? OTHER (Kindly Indicate)
YES
NO
OWN TRANSPORT DRIVERS LICENSE SMOKER
YES YES YES
NO NO NO
PUBLIC TRANSPORT CODE (Kindly indicate)
YES
NO
GEOGRAPHICAL PREFERENCES
CBD CAPE
PTA EAST PE
PTA NORTH DURBAN
CENTURION OTHER
HIGHEST QUALIFICATION OBTAINED
PRESENT REMUNERATION REQUIRED REMUNERATION TEMP ASSIGNMENTS
PER MONTH (GROSS/NET/CTC) PER MONTH (GROSS/NET/CTC) PER MONTH (GROSS/NET/CTC)
BLACK OTHER (Kindly indicate)
COLOURED
INDIAN
WHITE
DETAILS FOR REFERENCE PURPOSES (NB: CONTACTABLE WORK RELATED REFERENCES)
NAME
COMPANY(PREVIOUS EMPLOYER
POSITION
TELEPHONE NUMBER
NAME
COMPANY(PREVIOUS EMPLOYER)
POSITION
TELEPHONE NUMBER
PLEASE attach your Certificates / Diplomas. NO registration will be completed without the necessary documents. CONSENT: I hereby give my consent for Assignments on Contract (Pty) LTD to contact the above educational institutions and companies to obtain verification of studies and confidential references and also to provide such references as obtained to any potential employer. I also authorise Assignments on Contract (Pty) LTD Service Agents (namely MIE and the ITC) to conduct credit and criminal record checks on my personal particulars. I also give my consent for Assignments on Contracts (Pty) LTD to attach a copy of a photo or video clip of myself in order to market my CV more effectively to the client.
Are you aware of any Credit Records against your name: Are you aware of any Criminal Records against your name:
Yes . Yes .
No .. No ..
I confirm that all information provided on these application forms, to the best of my knowledge, is true and correct. I am also aware that any misleading or incorrect information provided will immediately disqualify this application. To this extent the seriousness of the misrepresentation is irrelevant.
SIGNATURE OF APPLICANT: ..
SIGNED ON THE
DAY Of
2013 AT
Personal Credential Verification Permission and Indemnity Declaration

(A) COMPANY DETAILS (The Company) To be completed by Company Agent PLEASE PRINT
Company Name: Branch Name: Agent Name:
Assignments on Contract Pty Ltd Assignments on Contract Pty Ltd Lebogang Mashigo
Kroll ID Validation Fraud Listing Sequestration Citizenship Deed Search TransUnion TransUnion TransUnion Experian Experian Experian
Email: LeboM@thomas.co.za Phone: 012 460 3471 Fax: 012 346 5965
Drivers License Professional Drivers Permit Permanent Residence
(B) CHECKS REQUIRED Criminal by Name/ID Qualification Employment Reference Passport Directorship Search Bureau Comprehensive Bureau Notices Bureau ID Verification
NOTE: Reason Code Required! Please select a Reason Code from the list below
** 1. Employment in a position that requires trust and honesty and entails the handling of cash or finances. 2. Verifying educational qualifications and employment ................................................... 3. Fraud detection and fraud prevention services............................................................. (C) PERSONAL INFORMATION Surname: Full First Names: Maiden Name: Primary ID No: 2nd ID / Passport: Res. Address: Date of Birth:
Code:
(D) QUALIFICATION INFORMATION (1) Qualification: Institution/School: City / Address: Date Obtained: Student No: Certificate No: Exam No: (2) To be completed by Candidate PLEASE PRINT (3)
(E) INDEMNITY DECLARATION
To be completed by Candidate SIGN and DATE
I hereby authorize the Companys duly authorized verification agent, Kroll Background Screening (Pty) Ltd (Kroll), to forward any personal information as well as any information that I have provided in support of my application to verification information suppliers acting on behalf of Kroll (including but not limited to the South African Police Services, the Government of the RSA, and any educational, training, credit bureau and fraud prevention organizations) for the purpose of verifying my personal credentials and records. Authorized credential verification types include, but are not limited to, educational qualifications, professional membership, employment history, employment references, consumer credit, criminal record, drivers license, and fraud prevention checks. I authorize Krolls verification information suppliers to furnish information regarding my credentials, whether claimed or not, to Kroll and the Company. I unconditionally indemnify Kroll and its verification information suppliers against any liability that may result from furnishing information in this regard. I understand that it is a condition of Krolls verification information suppliers that this information is furnished by them solely for the purposes of my proposed / continuation of employment via the offices of the Company and that any information that is furnished to the Company and Kroll will be disclosed to me before a decision is made on my continued employment or application for employment.
/
CANDIDATE SIGNATURE DD MM
/
CCYY
As the enquiring Agent of the Company, and in the case that this form instructs Kroll to provide consumer credit information, I hereby state that I understand the provisions of the National Credit Act (34 of 2005), section 70(2)(g), and the Regulations made in terms of the Act, section 18(4) and (5).
/
AGENT SIGNATURE DD MM
/
CCYY
All signatories to this document agree that Kroll will NOT be held liable for the content, factual correctness or accuracy of any Supplier Data supplied to Kroll for the Company by Krolls suppliers. The Company and the Candidate hereby indemnifies and holds Kroll harmless against any loss arising from neglect or damage in procuring, communicating or failing to communicate information to the Company

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Candidate Application Form & Kroll

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OUR SERVICE DOESNT STOP AFTER PLACEMENT, IT STARTS

PERSONAL / CONTACT DETAILS

INTERVIEW DATE SURNAME FIRST NAME

MR/MRS/MS KNOWN NAME

PERSONAL EMAIL ADDRESS WORK EMAIL ADDRESS

TEL NO HOME ALTERNATIVE CONTACT PERSON

POSTAL ADDRESS CODE

PHYSICAL ADDRESS CODE

NOTICE PERIOD (Kindly Indicate)

LAST POSITION HELD

ENTRY LEVEL PAYROLL/HR CA IT

DEBTORS/CREDITORS/CASHBOOK ACCOUNTANT COST & MANAGEMENT ACC ENGINEERING

ASSIGNMENTS ON CONTRACT (PTY) LTD |

LANGUAGES HOME LANGUAGE OTHER LANGUAGES 1. 2. 3. 4. 5.

READ READ READ READ READ

WRITE WRITE WRITE WRITE WRITE

SPEAK SPEAK SPEAK SPEAK SPEAK

WOULD YOU CONSIDER UNDERTAKING TEMPORARY ASSIGNMENTS?

ARE YOU SOUTH AFRICAN CITIZEN? OTHER (Kindly Indicate)

OWN TRANSPORT DRIVERS LICENSE SMOKER

YES YES YES

PUBLIC TRANSPORT CODE (Kindly indicate)

PTA NORTH DURBAN

HIGHEST QUALIFICATION OBTAINED

PRESENT REMUNERATION REQUIRED REMUNERATION TEMP ASSIGNMENTS

PER MONTH (GROSS/NET/CTC) PER MONTH (GROSS/NET/CTC) PER MONTH (GROSS/NET/CTC)

BLACK OTHER (Kindly indicate)

DETAILS FOR REFERENCE PURPOSES (NB: CONTACTABLE WORK RELATED REFERENCES)

ASSIGNMENTS ON CONTRACT (PTY) LTD |

ASSIGNMENTS ON CONTRACT (PTY) LTD |

Personal Credential Verification Permission and Indemnity Declaration

Company Name: Branch Name: Agent Name:

(E) INDEMNITY DECLARATION

To be completed by Candidate SIGN and DATE

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