Application Form Bursaries

Transcription

1 Application Form Bursaries Return this application form together with attachments to Sibanye Satellite Training Centres: Kloof, Driefontein Beatrix, Rustenburg and/or Central Campus. Only One application per person is accepted Please write clearly Complete all required Sections as indicated below Incomplete applications will not be accepted All applications should accompany an advertisement Clearly indicate Mining Operation where bursary vacancy exists (advertisement): Beatrix Driefontein Kloof Rustenburg Select bursary discipline applying for (as per advertisement): Mining Eng Electrical Eng Mechanical Eng Metallurgy Geology Rock Eng Survey HR Financial Accounting A-Stream Mining Select Your Status(x): COMPLETE THE FOLLOWING SECTIONS: A B C D E F Scholar X X - X X X University Student X - X X X X Mine Employee X X X* X X X *if applicable Individual (other than the above) X X X* X X X PLEASE DO NOT INCLUDE ORIGINAL DOCUMENTS The company will not undertake any responsibility for the safe keeping and/or return of any documents submitted with this application. In your own interest, therefore, rather submit legible copies of any such documents. The original documents must be brought to any interview that may be arranged. Review Date: Oct2018 Page 1 of 9 SSA/GTM/F020/R000

2 SECTION A BIOGRAPHICAL DETAILS SURNAME: INITIALS: FULL NAME(S): ID NUMBER: (Alt.) PASSPORT NO: D.o.B (yyyy-mm-dd) - - AGE: RACE: AFRICAN INDIAN WHITE COLOURED GENDER: MALE FEMALE DISABILITY: YES NO RESIDENTIAL ADDRESS SUBURB: TOWN / CITY: CODE: PROVINCE: PLACE OF BIRTH: Town / City: Province: ADDRESS: CONTACT NUMBER: - - Do you have family / relative working for Sibanye Stillwater? IF yes, please provide: Name of employee: Industry : Are you a community member of any of the Sibanye Stillwater Operations? If yes, which Operation: Review Date: Oct2018 Page 2 of 9 SSA/GTM/F020/R000

3 SECTION B SCHOLAR Please submit Proof of University application and/or acceptance letter Gr 12 latest school reports Indicate the university where you intend to study: WITS University University of Johannesburg University of Pretoria rth-west University OTHER: Please Indicate: What are your reasons for wanting to study at the above-mentioned University? What are your second and third preferences of University at which to study? te: Sibanye reserves its right to award a bursary subject to the candidate agreeing to study at a particular university Indicate Qualification Applied for: National Diploma BSc BEng BTech Other Qualification Name: Qualification Code: Review Date: Oct2018 Page 3 of 9 SSA/GTM/F020/R000

4 Education Secondary / High School: Name of Current School Date From Date To Highest Grade Passed Current Grade Do you have University Exemption? Do you have University Acceptance? Awaiting outcome Grade 11 and 12 results (please attach copies of your grade 11 and 12 academic records): Subject Grade e.g. HG/S Grade 11 % Grade 12 Latest results % te: A minimum of 60% in Maths, English and Physical Science is required Are you repeating any of your Gr 12 subjects? If yes, please indicate subjects you are repeating: Name of School: HG / S 1) 2) 3) Review Date: Oct2018 Page 4 of 9 SSA/GTM/F020/R000

5 SECTION C UNIVERSITY STUDENT Please attach: A copy of your full academic history Current Details: University: Qualification Type: National Diploma BSc BEng BTech Other Qualification Name: Current Year of Study: 1st 2nd 3rd 4th Other Year Started: Expected Graduation Year: Year Subjects: Result % Repeating (x) Qualification Applying for: Continue with current qualification New qualification: If you are considering any Post-Graduate studies (e.g. Honours) please indicate below: Review Date: Oct2018 Page 5 of 9 SSA/GTM/F020/R000

6 SECTION D BURSARY DETAILS Have you previously been interviewed for a Gold Fields Limited/GFA/Sibanye bursary? If yes, where and when? Did you previously have a bursary with Gold Fields Limited/GFL/GFBLA? If yes, complete the following: Year bursary was awarded to you: Discipline in which the bursary was awarded to you: Duration that you had the bursary for: Reason for you not being on the bursary scheme anymore: Do you have a bursary or are you receiving financial assistance from another source other than from your parents or relatives? If yes, complete the following: Name of the company providing financial assistance: Contact person at this company: Telephone number of the contact person: Review Date: Oct2018 Page 6 of 9 SSA/GTM/F020/R000

7 Employment Record including temporary or Vocational employment Employer s Name From To Occupation If you have been employed in the mining industry before, please supply your industry number: Review Date: Oct2018 Page 7 of 9 SSA/GTM/F020/R000

8 SECTION E GENERAL What do you like doing in your spare time (e.g. hobbies, interests etc?) What has led you to your choice of studies? How do you know this is the right choice for you? Have you had any vocational counselling to assist in your choice of degree (please provide details)? Please describe briefly how you see your choice and / or major subject being applied in your future career: Please list the three occupations that you would prefer to follow, in order of preference: What are your initial and longer term career goals / aspirations? Review Date: Oct2018 Page 8 of 9 SSA/GTM/F020/R000

9 SECTION F - DECLARATION Please answer the following questions: Have you carefully read the terms under which S is prepared to consider a bursary and do you agree to be bound by them if a bursary is awarded to you? You will be required to submit yourself to psychometric testing. Do you have any objection to this? The next question is to be answered by applicants who wish to study for a degree in Mining, Mechanical or Electrical Engineering or Geology, which will involve underground work. Have you any objection to working underground? The next question is to be answered by applicants who wish to study for a degree in Mining, Mechanical or Electrical Engineering, Metallurgical Engineering, Chemical Engineering or Geology, which will involve work requiring medical surveillance. Are you prepared to undergo a medical examination in order to apply for a Medical Certificate of Fitness? SIGNATURE OF APPLICANT: DATE: SIGNATURE OF GUARDIAN: (if applicant under 21 years of age) DATE: FULL NAMES & SURNAME OF GUARDIAN: WITNESS: DATE: WITNESS: DATE: Review Date: Oct2018 Page 9 of 9 SSA/GTM/F020/R000