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	DRIVER APPLICATION FORM

Document: SIN-HRR-FRM-001	Revision: 1	Page: 1 of 7	Effective Date: 1 August 2013
	Revision: 1	Page: 1 of 7	Effective Date: 1 August 2013



	Written by C. Viljoen	Reviewed by: T. Viljoen	Approved by: R. Viljoen

Operations Office 1st Floor, North Block, Alrode Multipark, JG Strijdom Road, Alrode, Johannesburg PO Box 11023, Randhart, Alberton, 1457 Tel: 0861 744 768 Fax: 0865 172 484 079 476 2944 (Henry)

PLEASE NOTE THE FOLLOWING:

QUALIFICATIONS: -

∙At least Standard Eight / Grade Ten

∙Valid unendorsed Code 10 /11/ EC1 or Code 14 / EC driver’s license

∙Valid Public Drivers Permit

AGE PROFILE: -

∙Between 25 and 45 years old

EXPERIENCE: -

∙Minimum of 2 years heavy duty driving

∙Long distance, urban driving with or without tanker experience

DATE OF APPLICATION

D D M M YY

XTick where applicable

1.PERSONAL DETAILS

1.1.Names:

Surname:

First Names:

1.2.Addresses:

Postal address

Postal code:

Residential

Title MR MS

Initials

Is this where you stay?

Yes No

1.3.Telephone Numbers:

Home:

Work:

Cellphone:

Other Contact Numbers:

1.4.Particulars Concerning Place of Birth, Age and Sex:

DRIVER APPLICATION FORM

Document: SIN-HRR-FRM-001

Revision: 1

Page:

2 of 7

Effective Date: 1 August 2013

Written by C. Viljoen

Reviewed by: T. Viljoen

Approved by: R. Viljoen

Place of Birth:

* Name of town:

Province:

Country:

* Is this your traditional home?

Yes

Nationality:

Permanent Residence Permit #:

Language:

Afrikaans

English

Zulu

Xhosa

Sotho

Tswana

San

Date of birth:

Identity Number:

Gender:

Male:

Female:

1.5.Marital Status and Related Matters:

Marital Status:		Married:	Single:

If married, spouses details:

* Names:

*	Occupation:

*	Qualifications:

* Address

Dependants:

*Number of Children:

*Parents:

*Other:

* Would your wife mind if you not staying at home?	Yes	No

1.6.Drivers License Details: (Copy to be attached)

Drivers licence:

* Code:

EC1

Date of issue:

Licence number:

Restrictions:

Expiry Date:

Copy must be attached

Professional Driving Permit #:

G.P

D.G.P

Issuing authority:

Expiry Date:


	DRIVER APPLICATION FORM

Document: SIN-HRR-FRM-001	Revision: 1	Page: 3 of 7	Effective Date: 1 August 2013
	Revision: 1	Page: 3 of 7	Effective Date: 1 August 2013



	Written by C. Viljoen	Reviewed by: T. Viljoen	Approved by: R. Viljoen

Copy must be attached

Do you have a Forklift Operators certificate?					YES		NO

* Expiry Date:	D	D	_	M	M	_	Y
	D	D		M	M		Y

Y Y

1.7.In what area would you prefer to work?

Province:	Tick:	Town:

Gauteng
Mpumalanga

Limpopo

North West

Free State

Kwazulu-Natal

Eastern Cape

Northern Cape

Western Cape

2.EDUCATIONAL RECORD

2.1.School: (Certificate to be attached)

Last school attended:

Period attended:

Highest grade passed:	Grade 7 /	Grade 8 /	Grade 9 /	Grade 10 /	Grade 11 /	Grade 12 /
Highest grade passed:	Std. 5	Std. 6	Std. 7	Std. 8	Std. 9	Std. 10
	Std. 5	Std. 6	Std. 7	Std. 8	Std. 9	Std. 10
Subjects passed:
Subjects passed:

Certified copy must be attached

Leadership roles:

2.2.Colleges / Universities:

Institution:

Period attended: Year

Diploma / degree:

Major subjects:

Awards:

3.SOCIAL INTERESTS

Your present sporting interests:

Your present cultural interests:


	DRIVER APPLICATION FORM

Document: SIN-HRR-FRM-001	Revision: 1	Page: 4 of 7	Effective Date: 1 August 2013
	Revision: 1	Page: 4 of 7	Effective Date: 1 August 2013



	Written by C. Viljoen	Reviewed by: T. Viljoen	Approved by: R. Viljoen

Other outside interests:

To which social, sporting club do you belong:

4.EMPLOYMENT HISTORY (At least 3 years)

4.1. Present or Recent Employment:

Company name:

Position held:

Company Address:

Telephone number:

Contact Person:

Salary per month:

Other benefits:

The dates below are very important

Date started employment:	D	D	_	M	M	_	Y	Y	Y	Y
Date started employment:			_			_

Date ended employment:	D	D	_	M	M	_	Y	Y	Y	Y
Date ended employment:			_			_

What kind of trucks did you drive?

What kind of trailers did you drive?

Reason for leaving:

4.2.Previous Employment:

Company name:

Position held:

Company Address:

Telephone number:

Contact Person:

Salary per month:

Other benefits:

The dates below are very important

Date started employment:

Date ended employment:

D	D	_	M	M	_	Y	Y	Y	Y
		_			_

D	D	_	M	M	_	Y	Y	Y	Y
		_			_


	DRIVER APPLICATION FORM

Document: SIN-HRR-FRM-001	Revision: 1	Page: 5 of 7	Effective Date: 1 August 2013
	Revision: 1	Page: 5 of 7	Effective Date: 1 August 2013



	Written by C. Viljoen	Reviewed by: T. Viljoen	Approved by: R. Viljoen

What kind of trucks did you drive?

What kind of trailers did you drive?

Reason for leaving:

4.3.Passed Previous Employment:

Company name:

Position held:

Company Address:

Telephone number:

Contact Person:


Salary per month:

Other benefits:

The dates below are very important

Date started employment:	D	D	_	M	M	_	Y	Y	Y	Y
Date started employment:			_			_

Date ended employment:	D	D	_	M	M	_	Y	Y	Y	Y
Date ended employment:			_			_

What kind of trucks did you drive?

What kind of trailers did you drive?

Reason for leaving:

5.	HEALTH

	Are you prepared to undergo a thorough medical examination?	Yes	No

	If not, why?

	May we test your urine and blood for substance abuse?	Yes	No

	Any current illness, disease or medical condition?

	Do you suffer from depression or mental illness?	Yes	No

	Do you use alcohol or drugs?	Yes	No

	Do you suffer from any physical disability, epilepsy or colour blind?	Yes	No

	Have you ever been involved in an accident?	Yes	No

	If yes, what happened:

6.	CRIMINAL RECORD

	Do you have a criminal record?	Yes	No

	If so, what was the offence?

What was the outcome of the case?

Suspended Sentence

Awaiting Trail


	DRIVER APPLICATION FORM

Document: SIN-HRR-FRM-001	Revision: 1	Page: 6 of 7	Effective Date: 1 August 2013
	Revision: 1	Page: 6 of 7	Effective Date: 1 August 2013



	Written by C. Viljoen	Reviewed by: T. Viljoen	Approved by: R. Viljoen

Sentenced: -Fined

Sentenced: -Jailed

Case Dismissed

Sentence: -Bail

Date of offence:

Judgment rehabilitated:

Yes

Have you ever been found guilty of drinking and driving?

Yes

Is your driver’s license currently suspended or endorsed?

Yes

May we check your criminal record with the police?

Yes

7.RELATIVES: Names and addresses of relatives not living with you

Name:

Address:

Telephone Numbers:

8.FRIENDS: Names and addresses of friends not living with you

Name:

Address:

Telephone Numbers:

Name:

Address:

Telephone Numbers:

9.Sizes

Overall size:

Jacket:

Pants:

Boot size:


	DRIVER APPLICATION FORM

Document: SIN-HRR-FRM-001	Revision: 1	Page: 7 of 7	Effective Date: 1 August 2013
	Revision: 1	Page: 7 of 7	Effective Date: 1 August 2013



	Written by C. Viljoen	Reviewed by: T. Viljoen	Approved by: R. Viljoen

I hereby authorize Staff Initiatives (PTY) Ltd duly authorize verification agent, Kroll MIE (PTY) Ltd, to forward my fingerprints, and any other personal information, to verification information suppliers acting on behalf of Kroll MIE (PTY) Ltd (including but not limited to the South African Police Services, the South African Criminal Record Centre,

the Government of the RSA, and any relevant educational, training and credit organizations) for the purpose of verifying my personal credentials and records. I further authorize Kroll MIE (PTY) Ltd’s verification information

suppliers to furnish information regarding my license, criminal, credit, professional and educational history to Kroll MIE (PTY) Ltd and Staff Initiatives (PTY) Ltd. I furthermore unconditionally indemnify Kroll MIE (PTY) Ltd 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 Kroll MIE (PTY) Ltd’s verification information suppliers that this information is

furnished by them solely for the purpose of my proposed / continuation of employment via the offices of Staff Initiatives (PTY) Ltd and that any information that is furnished to Staff Initiatives (PTY) Ltd and Kroll MIE (PTY) Ltd will be disclosed to me before a decision is made on my employment or application of employment.

I hereby certify that I understand and agree to the terms and conditions - Signature of Applicant:

Date:

SARS Tax Number: __________________________________________

BANK DETAILS

Savings:

Name of Bank: Branch Name:

Cheque:

Transmission:

Branch Code:

Bank Account No:

I hereby certify that the bank details are correct:

Signature:

How did you hear about Staff Initiatives?

Word Of Mouth

Flyer

Newspaper Advert

Other, pls give specifics

Question	Answer
Form Name	Form Sin Hrr Frm 001
Form Length	7 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 45 sec
Other names	si group jobs, si group, si group pinetown, si group recruitment contact details

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