Z83 Form Builder – Career Portals

B. Personal information

Surname *Full names *Date of birth (DD/MM/YY) *SA ID numberPassport number (non-South Africans) Race * Gender *

Race, gender and disability are asked on the official form for Employment Equity Act reporting. Your details must match your ID or passport.

Do you have a disability? * Yes No

Are you a South African citizen? * Yes No

Have you been convicted or found guilty of a criminal offence (including an admission of guilt)? * Yes No

Do you have any pending criminal case against you? * Yes No

Have you ever been dismissed for misconduct from the Public Service? * Yes No

Do you have any pending disciplinary case against you? * Yes No

Have you resigned from a recent job pending any disciplinary proceeding against you? * Yes No

Have you been discharged or retired from the Public Service on grounds of ill-health or on condition that you cannot be re-employed? * Yes No

Are you conducting business with the State, or are you a Director of a public or private company conducting business with the State? * Yes No

Years of experience: private sectorYears of experience: public sectorProfessional registration date (if required)Registration number

C. Contact details and medium of communication

Preferred language for correspondence * Method for correspondence *

Contact details (for the method above) *

D. South African official language proficiency

LanguageSpeakWrite / read

E. Formal qualifications (highest to lowest)

School / college / institutionQualification obtainedYear

Current study (institution and qualification)

F. Work experience (include current employer; also attach a detailed CV)

Employer 1

Employer 2

Employer 3

Employer 4

Employer 5

If you were previously employed in the Public Service, is there any condition that prevents your re-appointment? * Yes No

G. References

NameRelationship to youTel. (office hours)

A. The advertised post

Position you are applying for (as advertised) *Department where the position was advertised *Reference number (exactly as stated in the advert) *If offered the position, when can you start / how much notice must you serve? *

Email for your receipt & download link *

Instant EFT / OzowPay from your banking app (most major SA banks)

I consent to CareerPortals processing my personal information only to create this document. It is stored encrypted and deleted automatically after 30 days (POPIA). Privacy policy.

Please note: this is an unofficial, typed reproduction of the DPSA Z83 form provided for convenience; CareerPortals is not a government department. Always check the advert for the department’s requirements, then print, sign and initial the form yourself.