sample picture by lonyoo

VIEWS: 6 PAGES: 5

									    Old Mutual South Africa


    Graduate Accelerated
    Programme 2007



     sample picture
NOTE:

Please include:

    A copy of last year’s and this year’s most recent academic results

    A certified copy of your ID document

    A certified copy of a valid driver’s licence (where applicable)



The G1 form (included in the application form) must be completed and
returned with your application as it forms the first part of assessment for
your selection onto GAP.




                                                             Licensed Financial Services Provider
                                                                                                        Employment Application Form
                               Licensed Financial Services Provider




PLEASE NOTE THE FOLLOWING:
1. This document should be completed in your own handwriting. Please print.
2. Where necessary, please tick the appropriate block.
3. Please provide us with the following certified copies of your: ID document                         Professional qualification(s)          Latest salary slip




A       ACKNOWLEDGEMENT AND UNDERTAKING
I, the applicant, understand that the employment relationship between Old Mutual Life Assurance Company (South Africa) Limited (“Old Mutual”) and its
employees, is one based on trust and mutual respect, and that honesty and integrity is a fundamental and absolute requirement of the employment
relationship. I further acknowledge that in order to make an informed decision as to whether or not to enter into an employment contract with me, Old Mutual
will rely heavily on the veracity, accuracy and completeness of the information provided by myself during the entire recruitment process, including but not
limited to any information provided in terms of this application form. Against this background, I undertake to provide honest, accurate and complete
information.


B       PERSONAL DETAILS
Surname                                                                             First
                                                                                    name
Preferred name                                                                                                                             Title (Mr, Mrs, etc.)

Previous surname                                                                                                                         Date of
                                                                                                                                         birth     D D M M Y                     Y      Y     Y
Identity Number/
Passport Number

SA permanent resident          YES                    NO                                                          SA citizen       YES              NO

Home language                                                  Fluency in other
                                                               languages (if any)

For statistical purposes:         Disability (if any)                                                                                      Race

Do you have a valid SA driver’s licence?                YES             NO            Do you have any endorsements on your driver’s licence?                        YES               NO

Have you previously been employed at
                                                        YES             NO            If “YES”, please provide your old staff code
Old Mutual?


C       ADDRESS DETAILS
Residential address                                                                             Postal address


                                                                Postal                                                                                        Postal
                                                                code                                                                                          code


D       CONTACT DETAILS
Home:         (            )                                                                    Work:         (                )

Alternative/cell number:                                                                        E-mail/fax:



E       EDUCATION AND QUALIFICATIONS
 1) Completed
                                Year                                  Institution                                       Subjects                             Student Number
    Qualifications




 2) Current
                                Year                                  Institution                                 Subjects Completed                          Student Number
    Studies




 3) Training
                                Year                                  Institution                                       Subjects                              Student Number
    Courses




                                                                                                                                                             PLEASE TURN OVER

Old Mutual Life Assurance Company (South Africa) Limited. Reg no: 1999/004643/06            1
                                                                                                                                                         Governance – Recruitment and Selection, August 2006
F        MEMBERSHIP OF COMMUNITY OR PROFESSIONAL ORGANISATIONS
        Association/organisation                          Office held                                 Activities                                  Duration




G        WORK EXPERIENCE
    Previous employers: (starting with the most recent)
                     Company                    Start             End                    Position                            Reason for leaving




H        COMPUTER LITERACY
Please estimate your current level of computer literacy:
                                                        Introductory                          Intermediate                                 Advanced

    Microsoft Excel

    Microsoft Powerpoint

    Microsoft Word

    Outlook

    Other (please specify)

I        REFERENCES
If applicable, provide a name of a Referee at Old Mutual who can be contacted, to provide us with a reference regarding your working
competencies:
                            Name                                        Branch/Department                              Contact Telephone Number




OTHER REFERENCES
                                   Name of Contact          Position of Contact         Relationship with          Contact Telephone                    Period of
           Company
                                      Person                      Person                 Contact Person                 Number                         Employment




SECURITY DECLARATION
1.     Have you ever been charged with a criminal offence, professional misconduct or a regulatory contravention?                                 YES               NO

2.     Have you ever been found guilty of a criminal offence, professional misconduct or a regulatory contravention?                              YES               NO

3.     Is there a charge for an alleged criminal offence, professional misconduct or a regulatory contravention currently being                   YES               NO
       investigated/pending against you?
4.     Have you and/or your previous/current employer(s) ever been a defendant/respondent in civil proceedings relating to your                   YES               NO
       professional conduct?
5.     Have you ever been declared insolvent?                                                                                                     YES               NO

6.     Have you ever been charged with any disciplinary offence involving any form of misconduct at any previous/current employer(s)? YES                           NO

7.     Have you ever been found guilty of any disciplinary offence involving any form of misconduct at any previous/current employer(s)?          YES               NO

(If any “YES” answers, please give full details below)



J        DECLARATION, WARRANTY, CONSENT AND INDEMNITY
I, the undersigned applicant, hereby declare and warrant that the abovementioned information provided is true, accurate and complete. If I am successful in
obtaining employment with Old Mutual, I understand that failure to disclose true, accurate and complete information at the time of my recruitment, may, if
subsequently discovered, constitute ground for termination of my contract of employment. I authorise Old Mutual and its representatives to make enquiries,
conduct searches and verify the information provided by me in accordance with the recruitment process in Old Mutual and to act thereon. I indemnify
Old Mutual and its representatives against any liability toward myself or any third party (whether founded in contract, delict or other cause), which may arise
directly or indirectly from the enquiries, searches or verification of the above information.
I confirm that I have read and fully understand the contents of this paragraph.

Signed at                                                   on this                         day of                                                          20




Signature of Applicant:



Greenroom 08.2006 JB10585                                                                                                     Governance – Recruitment and Selection, August 2006
                                                                                 2
                                                                                         Employment Application Form
                                                                                                                 GAP
                              Licensed Financial Services Provider




PLEASE NOTE: This document should be completed in your own handwriting. Please print.



(i)     What kind of career are you looking for?




(ii)    List the leadership positions you hold/have held:




(iii)   What unique leadership attributes do you have that sets you apart from others?




(iv)    What will your epitaph say?




                                               Attach your most recent academic results – June/July 2006




                                                                                                                                             PTO

Old Mutual Life Assurance Company (South Africa) Limited. Reg no: 1999/004643/06   1
                                                                                                           Governance – Recruitment and Selection, August 2006
(v)       What vacation work have you done and what were your learnings about people from these experiences?




(vi)      Describe the achievement you are most proud of. The example provided must not pertain to University or Honours acceptance.




(vii)     What kind of person irritates you and why?




                                           Attach your most recent academic results – June/July 2006




        Greenroom 08.2006 JB10585                                             2

								
To top