Z83 Form Builder

The official DPSA application for employment (2021) required for public school and department posts. Your draft saves automatically.

A. The advertised post

Position applied forReference numberDepartment / schoolWhen can you start / notice period

SurnameFull namesDate of birthIdentity number

South African citizen?

Do you have a disability?

Convicted of a criminal offence?

Pending criminal case?

Dismissed for misconduct?

Pending disciplinary case?

Resigned pending disciplinary proceedings?

Discharged on ill-health / severance?

Conducting business with the State?

Will you relinquish such interests if employed?

Years of experience — private sectorYears of experience — public sector

Preferred languagePreferred correspondence methodContact numberEmail address

Professional bodyRegistration numberRegistration / expiry date

By signing below you declare that all information is complete, true and correct, and consent to verification under POPIA.

Signed at (place)Date

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