FORM EDU 1 AS REVISED NOVEMBER 2015

education
MPUMALANGA PROVINCE
REPUBLIC OF SOUTH AFRICA

APPLICATION FOR PERMANENT EDUCATOR POST

Mark with an X where applicable:

 Application for an
advertised post
 Application for first
temporary closed employment
 Application for closed
pro rata employment in
in the MDE the AET sector

 Application for
substitute closed
 Application for transfer
from another provincial
employment department

Institution/Office: ……………………………………… Circuit: …………………………………………………

NOTES:
(a) In the case of an application for an advertised post, FORM EDU 4: Notice of Assumption of Duty should only be submitted after the
applicant had received a formal offer of appointment from the Department and had subsequently assumed duty in the advertised post.
(b) In the case of an application for transfer from another provincial department, FORM EDU 1 should be accompanied by the conditional
approval of transfer from the Head of that provincial department or his/her delegate. FORM EDU 4: Notice of Assumption of Duty should
only be submitted after the applicant had received formal and final approval of the transfer from the Head of the Mpumalanga Department
of Education or his/her delegate and had subsequently assumed duty.
(c) If EDU 1 is not duly completed, this may result in the automatic disqualification of the application

PART ONE: PARTICULARS OF ADVERTISED POST (only in case of application for advertised post)

1. Institution: : …………………………………………………………………………
2. Post Designation: : ………………………………………………………………………..
3. Date of Vacancy List : ………………………………………………..
4. Post Ref Number :

PART TWO: PERSONAL PARTICULARS OF APPLICANT

1. PERSAL Number (if any):

2. SARS Ref Number:

2. Identity Number:

3. Surname: …………………………………………………………………………...
4. Initials:

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 FORM EDU 1 AS REVISED NOVEMBER 2015
YEAR MONTH DAY

5. Date of Birth

6. First names: …………………………………………………………………………..………

7. Title: DR MR MS
006 001 066
8. Residential Address :
Complex Number: ……… Complex name: …………………………………………….
Street Number: ……… Street name: …………………………………………….
Suburb / District: …………………………………………………………………………………
City Town: …………………………………… Postal code : ………………...
9. Dialing code: …………… Phone number: ……………….……………………
10. Postal Address: …………………………………………………………………………………
11. Post Office: …………………………………… Postal code : ………………...
12. Magisterial District: ………………………………..……………….
13. Population Group: BLACK COLOURED INDIAN WHITE

14. Gender: MALE FEMALE

15. Marital Status: MARRIED SINGLE DIVORCED WIDOWED

1 2 3 4

YEAR MONTH DAY

16. Marital Status Date:

17. Maiden Surname (if applicable): ………………………………………………………

18. Previous Marital Surname (if applicable): ………………………………………………………
19. Home Language: …………………………………. 20. Disabled: YES NO
21. Citizenship: …………………………………
YEAR MONTH DAY
22. Citizenships Date:

23. Place of Birth: ……………………………………………

24. Passport Number: …………………………………………..
25. SPOUSE DETAILS (only to be completed if applicant is married)
(a) Maiden Name : ………………………………………………………………………...
(b) First Names : ………………………………………………………………………...
(c) Title : ………………………..
YEAR MONTH DAY
(d) Date of Birth :

(e) Identity Number :

(f) Occupation : ………………………………………………………………..

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 FORM EDU 1 AS REVISED NOVEMBER 2015

26. NEXT OF KIN PARTICULARS

(a) Surname : ………………………………………………………………………...
(b) First Names: : ………………………………………………………………………...
(c) Relationship : ………………………………………………………………………...
(d) Postal Address : ………………………………………………………………………...
(e) Post Office : ………………………………………………………………………...
(e) Dialing code: : ………….. Phone number: ……………….………..

27. PRESENT EMPLOYMENT:

(a) Employer : ……………………………………………………………………..
(b) Institution : ………………………………………………………………………
(c) Salary Notch : ………………………………………………………………………
(d) Rank : ………………………………………………………………………..
(e) Bursary Holder : *YES NO
(f) *Bursary Name (if yes) :

28. REGISTRATION WITH SOUTH AFRICAN COUNCIL FOR EDUCATORS (SACE)

(a) Are you registered with the South African Council for Educators? : YES NO
(b) Registration number: …………………………………………………
(c) Registration date : ………………………….

29. GOVERNMENT EMPLOYEES PENSION FUND (GEPF) (if applicable including previous)
(a) Membership number: …………………………………………………
____________________________________________________________________________________________________________________

PART THREE: GENERAL PARTICULARS OF APPLICANT

1. DEPENDANTS:
NAME SURNAME GENDER DATE OF BIRTH RELATIONSHIP

2. LANGUAGE PROFICIENCY:
State the languages you can speak, read and write with an indication of good, fair, poor
LANGUAGE READ WRITE SPEAK

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 FORM EDU 1 AS REVISED NOVEMBER 2015
3. QUALIFICATIONS:
SCHOOL ATTENDED HIGHEST CERTIFICATE DATE SUBJECTS PASSED
OBTAINED OBTAINED

PROFESSIONAL QUALIFICATION DATE SUBJECTS PASSED

INSTITUTION ATTENDED OBTAINED OBTAINED
(DIDACTICS)

ACADEMIC INSTITUTION QUALIFICATION DATE SUBJECTS PASSED

ATTENDED OBTAINED OBTAINED

TECHNICAL INSTITUTION NTC III ETC DATE SUBJECTS PASSED

ATTENDED OBTAINED

Number of years apprenticeship : …………………………………….

Date completed : …………………………………….
Agreement number : …………………………………….
Trade : …………………………………….

FIELD OF FURTHER STUDY

………………………………………………………………………………………………………………………….

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 FORM EDU 1 AS REVISED NOVEMBER 2015
4. EXPERIENCE:
Teaching experience: (service certificate must be attached in case of transfers or appointment after break of service)
NAME OF DEPARTMENT INSTITUTION START DATE END DATE CAPACITY

Other experience: (service certificate must be attached in case of transfers or appointment after break of service)
NAME OF EMPLOYER START DATE END DATE NATURE OF EMPLOYMENT

Subjects you are able to teach: (The specific phase of teaching experience should be indicated in the column provided
i.e. Foundation, Intermediate, Senior, FET or a combination of the relevant phases)
SUBJECTS GRADES PHASE LANGUAGE IN WHICH YOU CAN TEACH
SUBJECT

State qualifications and/or proficiency in the following subjects and extra-mural activities if
applicable:
Subjects
Music : ……………………………………………………………………………………..
Song : ……………………………………………………………………………………..
Arts & Craft : ……………………………………………………………………………………..
Art : ……………………………………………………………………………………..
Elocution / concert : ……………………………………………………………………………………..
Physical Education : ……………………………………………………………………………………..
Other: : ……………………………………………………………………………………..
: ……………………………………………………………………………………..

Extra-mural activities
Athletics : ……………………………………………………………………………………..
Soccer : ……………………………………………………………………………………..
Rugby : ……………………………………………………………………………………..
Netball : ……………………………………………………………………………………..
Hockey : ……………………………………………………………………………………...
Other: : ………………………………………………………………………………………
: ………………………………………………………………………………………

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 FORM EDU 1 AS REVISED NOVEMBER 2015
PART FOUR: EMPLOYMENT HISTORY

1. Have you ever:

(a) Been found guilty of misconduct? YES NO
(b) Been convicted of a criminal offence? YES NO
(c) Been dismissed from employment? YES NO
(d) Been granted the Voluntary Severance Package? YES NO
(e) Retired due to ill health? (recent confirmation letter of the registered medical practitioner YES NO
pertaining to current health status to be attached)
(f) Taken early retirement or resigned from the public service? YES NO
In the event of a “Yes” response to any one of the questions above, a separate report with all the
relevant details shall be compiled and attached in order for the Department to consider your
appointment as an educator. The information below is also required.

(g) Date of exit as a result of the event indicated in section 1(a) to (f) above? ……………………...
(h) Department at the time of the event indicated in section 1(a) to (f)?
………………………………………………………………………………………….
(i) Institution at the time of the event indicated in section 1(a) to (f)?
…………………………………………………………………………………………..

2. ATTACHED HEREWITH THE REQUIRED ORIGINALLY CERTIFIED COPIES (Not older than 3 months) OF ALL
RELEVANT DOCUMENTS:
i School Certificate
ii Professional Qualification(s) plus academic transcript(s)
iii Academic Qualification(s) plus academic transcript(s)
iv Certificate(s) of Service
v Identity Document (must be bar coded document)
vi Valid Passport
vii Proof of permanent residence document
viii Marital status certificate(s) (must – apart from “single”- substantiate the status noted under Section 17)
ix SACE Certificate as proof of registration with the South African Council for Educators
x Testimonials

I DECLARE THAT ALL THE PARTICULARS INDICATED IN THIS DOCUMENT ARE TRUE AND CORRECT.
I UNDERSTAND THAT ANY FALSE OR INCORRECT STATEMENTS WILLFULLY MADE WILL TENDER ME LIABLE TO
DISCHARGE ON ACCOUNT OF MISCONDUCT.

____________________________ ___________
SIGNATURE OF APPLICANT DATE

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 FORM EDU 1 AS REVISED NOVEMBER 2015
PART FIVE: RECOMMENDATION AND APPROVAL
Post specific requirements: The educator is deemed suitably skilled to teach the subjects and/or phases as indicated in
Table A below, and is therefore recommended for appointment.
Table A: Subjects to be taught (Tutoring Subjects):

Subject(s) Grades Phase Language in which subject(s) will be taught

Appointment of Mr/Ms …………………………………… as …………………………. (rank) to the advertised Post No

…………………………in the Vacancy List dated …………………, is herewith recommended / not recommended.

Transfer of Mr/Ms ………………………………from ……………………………….………………….(other education

department), is recommended / not recommended.

Appointment of Mr/Ms …………………………………… as a Grade R educator, is herewith recommended / not

recommended.

Placement of Mr/Ms ………………………………….., a Bursar from the ……………………………………Bursary Scheme

is herewith recommended / not recommended.

__________________________________ __________________________
CHAIRPERSON OF GOVERNING BODY DATE

__________________________________ __________________________
HEAD OF INSTITUTION DATE AND OFFICIAL STAMP
_________________________________________________________________________________
Appointment of Mr/Ms …………………………………… as …………………………. (rank) to the advertised Post No
…………………………in the Vacancy List dated …………………, is herewith recommended / not recommended.

Transfer of Mr/Ms ………………………………from ……………………………….………………….(other education

department), is recommended / not recommended.

Appointment of Mr/Ms …………………………………… as a Grade R educator, is herewith recommended / not

recommended.

Placement of Mr/Ms ………………………………….., a Bursar from the ……………………………………Bursary Scheme

is herewith recommended / not recommended.

Remarks:
…………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………….

__________________________________ __________________________
_______________________ _________________________
CIRCUIT MANAGER / CES DATE AND OFFICIAL STAMP

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 FORM EDU 1 AS REVISED NOVEMBER 2015

APPROVAL BY DELEGATED OFFICIAL

Appointment of Mr/Ms …………………………………… as …………………………. (rank) to the advertised Post No

………………………….……in the Vacancy List dated ……………………….., is herewith approved / not approved.

Transfer of Mr/Ms ………………………………from ……………………………….………………………...(other education

department), is approved / not approved.

Appointment of Mr/Ms …………………………………… as a Grade R educator, is herewith recommended / not

recommended.

Placement of Mr/Ms ………………………………….., a Bursar from the …………………………………Bursary Scheme,

is herewith approved / not approved.

Remarks:
……………………………………………………………………………………………………………………………
……..……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
……..……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………

____________________________ ______________ ____________ __________

NAME OF DELEGATED OFFICIAL RANK SIGNATURE DATE

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