SETS7 Z83 (81/971431)

Republic of South Africa

APPLICATION FOR EMPLOYMEHT

A. THE ADVERTISED POST (All sections of this form are compulsory)

was advertised
Position for which you are applying (as Departrment where the position
WHAT IS THE PURPOSE OF THIS FORM advertisod) ( a N A |DEEPARTnET
To assist a govemment department in
when can you
selecting a person for an advertised post. Reference number (as statod in the advert) If you are offered the position,must you 3erve
start OR how much notice
with your current employer?
This fom may be used to identify candidates
to be interviewed. You need to fill in all
sections of this fom completely, accurately
and legibly. This wil help to process your
application fairly.
PERSONAL INFORMATION!
WHO SHOULD COMPLETE THIS FORM
Surname and Full names
TLON1E
Only persons wishing to apply for an KACoODOELICA
advertised position in a govemment Identity
department. Date of Number
Birth Passport
number
ADDITIONAL INFORMATION
Race African lX White Coloured Indian Other
This fomm requires basic infomation. Gender Female Male
Candidates who are selected for interviews
willbe requested to fumish additional certified Do you have a disability? Yes No
information that may be required to make a No
final selecion. Are you a South African citizen? Yes

SPECIAL NOTES
If no, what is your nationality?
Yes Nc
Do you have a valid work permit? (only if non-South African)
Have you been convicted or found guilty of a criminal offence Yes No
1- All information will be treated with the (including an admission of guilt)? 5
strictest confidentiality and will not be If yes (provide the details)
disclosed or used for any other purpose than Yes No
toassess the suitabilty of a person, except in Doyou have any pending criminal case against you?
so far as it may be required and permited by If yes, (provide the details)
law. Your personal details must correspond No
with the details in your ID or passport. Have you ever been dismissed for misconduct from the Public Yes
Service
2- Passport number in the case of non If yes (provide the details)
South Africans. Yes No
Do you have any pending disciplinary case against you? 2
3- This information is required to enable the If yes, (provide the details)
department to comply with the Employment
Yes No
Equity Act, 1998. Have you resigned from arecent job pending any disciplinary
proceeding against you?4
4- This information wil only be taken into If yes, (please note that the provisions of the Public Service
account i it directly relates to the Act shall apply).
requirements of the position. Have you been discharged or retired from the Public Service Yes No
grounds of ll-health or on condition that your cannot be re
5- The Executive Authorty shall consider the employed?
ciminal record (s) against the nature of the Are you conducting business with the State or are you a Yes No
job functions in line with internal infomation
Director of a Public or Private company conducting business
security and disciplinary code. with the State? If yes, (provide the details)
6- The applicant may submit additional Yes No
information separately where the space In the event that you are employed the Public Service, will
provided is not sutficlent. you immedlately relinquish such business interests?
Private Public Sector
7. Departments must accept certifled Please specify the total number of years of experience you Sector
documents that accompany the have
application(s) with certification that is up
to 6 months, unless the advert prescribes If your profession or occupation requires oficial registration, Date Reg. No
a longer period. provide date and particulars of registration

Initial.
Page 1 of2
 Z83 (81/97143 1)

8- Each applcation for employment form CONTACT DETAILS AND MEDIUM OF COMMUNICATIONS
C
must be duly signed and initlaled by the
applicant. Failure to sign this fom may lead Preferred language for correspondence
to disqualification of the application during
the selection process. Tel
Method
correspondence
for
Post E-mall > Fax

Contact details
terms of the above)
(in
elseoorearai.(o
|O127s00oAU)on3ASTO
D.SOUTH AFRICAN OFFICIAL LANGUAGE PROFICIENCY - state 'good', fair, or 'poor
Languages (specify)
ENoEEPEDTSTDEBEE
Speak
Write or read

E. FORMAL QUALIFICATION (from highest to the lowest)

Year obtained
Name of School/Technical College Name of qualification obtained

|FEJ ColEUE lARLETIN a . Ny

Sol3
Current study (institution and qualification):

F. WORK EXPERIENCE (Also attach a detailed CV)s

Employer (including current Post held From To Reason for leaving
employer)
MI
(oriRACT
EsTHER CH,S
(oRAT
If you were previously employedin the Public Service, is there any condition that prevents your re- Yes No X
appointment
If yes, Provide the name of the previous employing department and indicate the
nature of the condition.

G. REFERENCES

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

|r. Wandile EuEVsOR

Tr6.Kmaue VIcE PRnaPLE

DECLARATION
declare that al the information provided (including any attachments) is complete and corect to the best of my knowledge. I understand
that a0vfalse infomation provided will result in my application being disqualifed or disciplinary action taken against meif lam appointed:
Date:
Signature:
Bloula

Page 2 of2 Initial......

 CURRICULUM VITAE OF KHOMOTJO TLOWANE
PERSONAL DETAILS
Surname
Maiden name
Tlowane
: Manyaka
Full names : Khomoljo Elisa
Date of Birth 07 Apil 1986
ldentity Number 8604070333084
Marital Status Married
Nationality South African
Home Language Sepedi
Oher Languages: Ndebele, English, Zulu, Afrikaans, Tswana
Drivers License Code 10/ C1

CONTACT DETAILS
Cell phone :072780 0094
Alt.cell phone :073 919 5770
E-mail :[email protected]
Postal Address :Private bag x9633
Marble- hall
0450
Residential Address: Stand 2295
Marble-hal
0450

EDUCATIONAL QUALIFICATION
Senior Certificate
School :Lehlasedi Combined School
Year Obtained :2005

Subjects Obtained
Sepedi
English
Afrikaans
Biology
Geography
Agricultural Science

TERTIARY QUALIFICATION
Institution Ithemba Nursing Academy
Qualification : Nursing Auxiliary
Year Obtained :2015

1
Institution :Further Education and Training Colege
National Certificate N4 Marketing Management
Qualification
Year Obtained 2007

Subjects
Marketing Managements N4
Entrepreneurship and Business Management N4
Management Communication N4
Computer Practice N4

Certificates Obtained

1.Computer Diploma

EMPLOYMENT HISTORY

DEPARTMENT OF EDUCATION
INSTITUTE:Esther Maleka Comprehensive High School
POSITION: Admin Clerk (Internship Program)
DURATION: June 2018 to May 2019
DUTIES PERFORMED: Typing, filling, reception, faxing, photocopying and switchboard duties.
records
distribution of information and documents. Maintain
Deal with the collection duplication and income and outgoing mails and cals. Deal with
and management information. Handle all catering. Handle learner's admission,
arrangements for meetings, workshops, travelling and SA-SAMS.
in the admission book. Data capturing on
receiving applications, entering new learners
receipt. Taking care of learners in the sick room.
Receiving cash from learners and issuing

EPHRAIM MOGALELOCAL MUNICIPALITY

POSITION: Project/Community Liaison Officer
DURATION: January 2017 to August 2017 represent the
progress report to local municipality. To communication
DUTIES PERFORMED: Writing monthlysub-contractor and the employer with their
community and to assist the contractor, candidates, to inform them of the condition of
screening
vice versa. To be responsible for timeouts repoting for duty. To identify
suitable labour to
temporary employment and to ensure their labour from the
of the contractor and sub-contractor. To ensure that all
satisfy the requirements are fully
activities where productivity rates are specified
local community who are involved in with the contractor, sub-contractor and employer ona daily
informed regarding the task. To consult regarding amount, skills and condition of employment.
requirements
basis to determine the labour
JETMART STORE
POSITION: General Worker
DURATION: July 2008 to March 2010
Control, Floor Assistant and Filling
DUTIESPERFORMED: Cashier, Slock
MUNICIPALITY
EPHRAIM MOGALE LOCAL

2
 POSITION: General Worker
DURATION: June 2010toJanuary 2011
DUTIES PERFORMED Perform road maintenance aclivities

LEPELLE NOTHERN WATER

POSITION: General Worker
DURATION: March 2011 to Juy 2011
DUTIES PERFORMED: Cleaning of dam and cutting of trees

OTHER COMPETENCIES: Hard Working,Presentation Skill, Good Repot Witing, Record Keeping. Conllict
Resolution and Administration.

COMPUTER PACKAGES: Microsoft Word, Excel, Outlook,Power Point and Internet

REFERENCES
Mrs. R.A Miller
Esther Maleka Comprehensive High School
Position :Principal
Tel no :072 992 7014
Mr. T. Phasha
Ephraim Mogale Local Municipality
Position :Project Manager
Tel no :(013)261 2985
Mr. Mmatli S
Lehlasedi Combined School
Position :Principal
Mobile 072 968 0367
Relationship :Teacher
MRS.C Choshane
ITHEMBA NURSING COLLEGE
Position :Lecture
Tel no :079 852 0230
:012 8066104
Relationship : Tutor
Mrs. M Ngwetsane
Lepelle Northern Water
Position production officer
Tel no :(013) 261 1088
Relationship :Supervisor

3
 This card has Condi tions:
Depart m ent of been issued by the Date of Issue
ldentenalum Home
ifplereication Act, ActAtfalrs
68 of 199in terms of the 28 JUL 2016
Vfeund
Par in the Oenatm REPUBLICOF SOUTH AFRICA
nmearien purrs Home Affais NÁTIONAL IDENTITY CARD
RSA Surnamo
TLOWANE
Narnes.
102584880 KHOMOTJO ELISA
3ex

Nationalily
tdenlily Number.
R604070333084
Dale
Dale of Binh:
APR 19086
Counlry of Birth Signature:
Status:
cíTI}EN

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MAA DNEMINGG, DAAR N

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 UMALUSI
Councilfor Qualitp Assurance in eneral
and1further Education andTraining

SENIOR CERTIFICATE
SETIFIKEITI SA SENIOR

Awarded to/Se filwe

KHOMOTJO ELISA MANYAKA

Identity number 860 4070333084 Nomoro ya Boitsebi ao

tseotswAUTHAFRICAN POLICE SERVIGE

oU0jects passed | Dithuto MARBLE HALL POLICE

Sepedi : First Language HG 503-59%

Afrikaans : Second Language 2023 -N4- 12 HG 40%-49%
English: Second Language HG 503-59%
Geognaphy ¿CLIENT SERVICE CENTOE
SG 403-49$
Agricultwnal Science SUID-AFRiKAANSE PO SG 33,38-39$
Biology LG 33,38-39%
Aggregate / PalomhakelooTE 720-949
OECNG***
DIS NIE.
********

I CERIFY TAT
CRIoINA DTtUENY
IS A
T NCH WAS TALEFCPRODUCTION (UOPY
ARiER CSRT T:AT, FPO MYiANDID TO IE FOR AUTHENTICAT
SEAVATIONS, ANAMENDMENT Og
/DOCUMENT

MAGSNOMMER HSTeNNG/SIGNATURE
FORCE NUMBER.
RANK
NAAM IN DRUKSKRIF
NAME IN PRINT..

ENDORSEMENT
None
TI`ET`O
Ga e gona

With effect from

Decembar/Disemere 2005 Go thoma ka

Chíef -Execut ive 0fficer

This certificate is issuod in accordance with
Mohl ankedimogo lophethisi
Soction 16(4) (o) of Act 58 of 2001 by
Umalusi Councíl for Quality Assuranco in Genoral and Furthor Educatlon and Teaining.

060 2328 5074 J

REPUBLIC OF.
SOUTH AFRICA
This cortificate is issuod without altoratian r orasuro of any kind
 SOUTH AFRICAN NURSINGCOUNCIL

CERTIFICATE OF REGISTRATION
UNDER THE PROVISIONS OF THE NURSING ACT No. 33 OF
2005
IT IS HEREBY CERTIFIED THAT

KHOMOTJO ELISA MANYAKA

(IDENTITY No. 8604070333084)<.
C
WAS REGISTERED ON
CE CENITOE
29 MAY 2015 N.ANSE PC
AS
DORSPRCH
BISNE
NURSING AUXILIARY
ORGIN DOCUi
SRTNE?
CNANGE AAETER EXAMINATION.

MAGSHOMMER
FORCE NUMBER.... AtoTEKENING/SIGNATIIRE
RANG
NAAM IN
RANK

DAUKSKRIMhmy
NAME IN PRINT.
GIVENAT PRETORIA UNDER THE SEAL OF THE
This certificate is issued without any erasure or
mentioned person's continued registrationalteration
COUNCIL.
of any kind and is subject to the above
with the South African Nursing Council.
This certificate is proof of registration
for a period of one year after the date
of registration and thereafter an annual
practising certificate, issued
payment of the prescribed annual fee,
fee
is proof of registration -section 36(2)
of the Nursing Act, 2005.

Registrar
Certificate Number: 201523014 Date Issued: 28 AUGUST 2015
 SOTH AFRUCAN FOLICE SEKVICE
MARBLE HALL POUCE

2023 -F4- 1 2
CLIENT SERVICr CENTRE
XARNA SUID-AFRIKAANSE POLISIEDILNS

DEPARTMENT: EDUCATION /bEPARTEMENT: ONDERWYS

REPUBLIc OF SOUTH AFRICA /REPUBLIEK VAN SUID-AFRIKA

NATIONAL NASIONALE
CERTIFICATE N4 SERTIFIKAAT
MARKET ING MANAGEMENT BEMARKI NGSBESTUUR

AWARDED TO TOEGEKEN AAN

MANYAKA KHOMOTSO ELISA

IDENTITY NUMBER IDENTITEITSNOMMER

8607040333084
WITH EFFECT FROM MET INGANG VAN

2007-12-01
INSTRUCTIONAL OFFERINGS PASSED ONDERRIGAANBIEDINGE GESLAAG
INDICATES DISTINCTION DUI ONDERSKEIDING AAN
MARKETING MANAGEMENT N4 BEMARKINGSBESTUUR N4
ENTREPRENEURSHIP AND BUS INESS ENTREPRENEURSKAP EN
MANAGEMENT N4- ONDERNEMINGSBESTUUR N4
MANAGEMENT COMMUNTCATION NAERLE MANAGEMENT COMMUNI CATION N4
COMPUTER PRACTIICE N4 KUMC REKENAARRRAKTYK NA
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Examination Officer Director-General

Eksamenbeampte Direkteur-generaal
19142862M
SERIAL NUMBER 185027 REEKSNOMMER

GPS o08-9589
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REG NO: 200720695223
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MENEAIONE
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TAX NO: 9447162166

TRAINNING
Accreditation Number: ACCI2009/09/574

MAR3LE HAL POUCE

CIrT SEOVCr CrNITOE
This isto certify that:
MANYAKAKHOMOTO SA
ID NO, 860407 0333 0S 4
and shown
Has passed and fulilled the requirements
competency in the following NQF L3courses:
INTRO-TO-COMPUTERS
WINDOWS 2000/XP/VISTA/07n sVAN
COMMUNICATION SKILLS
ORSPEOINKLIKE DA AANGr
DOKUMENT

.ADANGE TYPLNG SKILLS (COPY) OF TAE

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MADA TO
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CERTIFIE

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DEVELOPMENT
MEMBER OF MICROSOFT
ACCREDITED BY.MIÇT SETA &SAQA
14 AUGUST 2013
Date of Issuc
ASSESSOR
MANAGING DIRECTOR Refcrence Number
LN2013 08 041

without any akeration or erasures.

Issucd as an uriuinal docuMCnt
E-al: newarizoMuQy uail.com
Cell: 076 (080 J75
 LIMPOPO
PROVINCIAL GOVERNMENT
REPUBLIC OF SOUTH AFRICA

Course no.: RSA Point Duty 1/2022

Department of
Certificate no.: RSA0092/2022 Transport and ConmmUnity Safety

Traffic Training College

(Approved in terms of the National Road Traffic
MARBL AL POLICE
CLIFN Sronr-n4-CENT12OE
KSREAT
NRIKE HIAUE OKUMET N
AKR DOKUMENT
VERDER DAT, WAT AAN MY
VOLGENS MY WAANELA
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Certificate
MA
FOsMME bocUMEW.
NAAN

K E Tlowane
rEKEMNSo RANG
RANK

Identity Number: 860407 0333 084

Attended Point Duty Training course presented by the Limpopo Traffic Training
College over the period two weeks; was assessed and found competent - on Road
Safety Ambassador Point Duty of which this certificate is awarded:

POINT DUTY AMBASSADOR

CCPI: In-Service Training Head of College

Signed at Limpopo Traffic TrainingCollege this 15th day

of December 2022