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Application

Accommodation and Waiting List

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Huis Uitsig
Application

General Information:

Banking Details:

General Questionnaire:

Can we contact your previous employer(s) to obtain references?:
Have you ever been charged or convicted for a criminal offence?:
Do you suffer from any illness / disabilities?:

Previous Employment History:

Have you ever been dismissed from a previous employer for any misconduct, ill Health or poor Work Performance?:

Availability to work:

The nature of the position will require an employee of the organization to work on Saturdays, Sundays, Public Holidays. Please state your availability and undertaking:
Are you able and willing to work on Saturdays and Sundays?:
Are you able and willing to work on Public Holidays?:
Are you able to work Night Shifts and Day Shifts according to a Shift Roster?:
Are you willing to rotate from Day Shift to Night Shift on a frequent basis when instructed to do so?:

Medical Questionnaire:

Have you ever (or are currently) receiving medical treatment for one of the following conditions?:
Epilepsy
Heart-Disease / Operations:
Lung-Disease / Operations:
T.B
Cancer
High Blood Pressure / Hypertension
Back pain and/or injuries
Internal Injuries
Migraine / Headaches
Ulcers
Do you smoke?
Did you have Covid?
Are you vaccinated?
Previous injury on duty?

Declaration:

THE FOLLOWING DECLARATION APPLY: I, the undersigned, acknowledge and confirm that:- 1) All information declared by me in this application form is true and correct and that any false and/or misleading information will automatically and immediately render my employment null and void. 2) I willingly authorize the company to undertake any credit or criminal checks which it may consider appropriate. 3) I am not aware of any medical condition that would render me unable to perform any duties that I am appointed for. 4) The address provided for shall be the address which all correspondence will be delivered. 5) It is the responsibility of the employee to inform the employer of any changes to the information provided in this document.
SIGNATURE: By typing out my full name below, I am signing this document and declare that all information provided is true and correct and all attachments valid.

Position Applying for:

Please tick the position (s) you are applying for:

Please attach the relevant documentation:

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