Candidate Application and Confidentiality Form
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Full Name
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Email Address
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Date
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DD slash MM slash YYYY
Position Applying for
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Have you applied for this role directly/with another agency?
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Yes
No
If yes, please specify (application path and date)
I hereby consent to the following:
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I agree
That I have furnished MNA Recruitment with my personal information and details and agree that they have access to this information.
I agree that my personal information and details may be sent to hiring companies (with company specific consent), with the objective of applying for a position within the company.
I agree that MNA may share my information with the companies and parties involved in the recruiting process applicable to each vacant position, including consent to MNA’s duly authorised agent, LexisNexis Risk Management (LNRM) and it’s data providers to process my personal information and conduct background verification checks including but not limited to; credit, criminal, qualifications, employment vetting, references and employment salary verification, fraud prevention, ID verification, FAIS comprehensive, professional associations, driver’s licence, social media and any other relevant checks in the pre- and post– employment vetting process.
I understand that all personal information is disclosed in confidence and will be kept confidential in a secure manner by the Company and LNRM;
I authorise the communication of the results of the background checks to the Company and LNRM who, inturn, will keep a copy on record, as per company policy;
I understand that MNA will treat my personal information and documentation with confidentiality and that MNA will not share this information with any 3rd party or marketing companies not involved with the recruitment / on boarding processes.
I agree that MNA may store my personal information and that I have access to this information, including the right to have my data removed in line with the Protection of Personal Information (PoPI) Act of South Africa.
Personal Information
Full Name
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First
Last
Known as
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Nationality
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Race
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Gender
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Marital Status
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Maiden name (if applicable)
Dependents
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Location
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Language Proficiency
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ID Number
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Notice Period
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Immediate
Two Weeks
30 Days
Calendar Month
If longer, please stipulate
Background Checks and Verification
References (Previous Line Managers, most recent Employers)
Employer Name (Company)
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Referee Name
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Designation
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Contact (Cell) Number
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Email Address
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Employer Name (Company)
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Referee Name
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Designation
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Contact (Cell) Number
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Email Address
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Employer Name (Company)
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Referee Name
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Designation
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Contact (Cell) Number
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Email Address
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Do you have a negative Credit Record? (Ie. Defaults on payments recorded at Credit Bureau)
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Yes
No
If you do, please explain
Have you ever been criminally charged?
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Yes
No
If yes, detail of charge/conviction
Has any disciplinary action been taken against you at a previous or current employer?
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Yes
No
If yes, please explain
Remuneration Details
Please provide as much information as possible, as benefits may not always reflect on payslips.
Total Annual CTC including Incentives
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Total CTC excluding Incentives
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Nett Salary
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Basic Salary
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Vehicle Allowance/Company Car
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Medical Aid Company Contribution
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Medical Aid Own Contribution
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Pension Fund Company Contribution
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Pension Fund Own Contribution
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Other Benefits
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Incentives
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13th Cheque
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Desired Package
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Desired Nett Salary
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Disclaimer and Signature:
I certify that the information I have provided is true and complete to the best of my knowledge. Should this application lead to employment, I understand that false or misleading information provided during my application or interview may result in breach of contract and possible dismissal.
Signature
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