Register Which date are you available for placement? Do you have a criminal record?YesNoHave you ever been arrested?YesNoIf yes, do you have police clearance?YesNo1. PERSONAL INFORMATIONName as on passport Surname ID Number Date of birth Age Mobile Number WhatsApp number Personal E-mail Address Marital status Current addressPlace of birth Contact person in case of emergency (ICE) Relationship to Person (ICE) Contact number (ICE) 1.A. PASSPORT AND VISA INFORMATIONExpiry date of current passport Passport number Nearest/preferred consulateCape TownJohannesburgDurbanMaseruHave you ever been denied a visa?YesNoIf yes, which consulate? When? Stipulate reason Has your visa ever been cancelled?YesNo1.B. HEALTH CONDITIONSmoking habitNeverOccasionalModerateHeavyAlcohol useNeverOccasionalModerateHeavyDo you have any health problems (allergies, disabilities, serious medical condition)?YesNoIf yes, provide details1.C. EDUCATIONObtained national senior certificate/high school diploma?YesNoList college / university / other degree(s) or certifications obtained1.D. LANGUAGE SKILLSEnglish speaking and listeningExcellentGoodFairPoorEnglish reading and writingExcellentGoodFairPoor1.E. EMPLOYMENTNote: South African employment information compulsaryPresent or last employer Position Job description AddressSalary per month Date started Date ended (if applicable) Contact number Alternative contact person Are you from a farming background?YesNoIf yes, what type of farming?CropsCattleDairyOther1.F. PREVIOUS USA EMPLOYMENT AND VISA INFORMATIONOnly for visas issued in RSARecent USA employer’s name and location Contact person Contact details VISA date issues VISA expiry date USA date arrival USA departure date VISA number and type 1.G. GUARDIANSHIP INFORMATIONIf you are under the age of 21Name of legal guardian Relationship to applicant AddressContact number Describe yourself and your skillsPhoto (compulsary)Upload Photo (compulsary)Upload2. WORK EXPERIENCE Only fill in if you are not human
