Experiential Learning Application Form About You Main email address: First name: Middle name (if applicable): Preferred name (if applicable): Last name: Preferred contact number: Home address: Home telephone number: Term time address: ID number: Do you hold a full and valid driving licence?:

Yes

No

Do you require a work permit to work in South Africa?:

Yes

No

About Your Studies Please list all Matric subject details below: Subjects Maths Science English

A A A A A A A

B B B B B B B

Old Curriculum C D E C D E C D E C D E C D E C D E C D E

F F F F F F F

8 8 8 8 8 8 8

7 7 7 7 7 7 7

6 6 6 6 6 6 6

New Curriculum 5 4 3 5 4 3 5 4 3 5 4 3 5 4 3 5 4 3 5 4 3

Please select the University of Technology where you are currently studying for your degree: Cape Peninsula UT: UJ: Central UT: Unisa: Durban UT: Nelson Mandela Metro: Mangosuthu UT: Venda: Tschwane UT: Walter Sisulu: Vaal UT: Zululand: Please select the degree subject you are currently studying: Mechanical: Instrumentation: Electrical (Heavy Current): Automation: Electrical (Light Current): Metallurgy: Other:

2 2 2 2 2 2 2

1 1 1 1 1 1 1

Please select in-service training required: P1: P1 & P2:

P2: Other:

Please list all relevant modules studies so far at university and grades obtained: (please attached a copy of your academic record)

Work Experience Company: Date From: Date To: Job Title: Manager’s Name: Type of work and responsibilities: Company: Date From: Date To: Job Title: Manager’s Name: Type of work and responsibilities:

Why you want to carry out in-service training at Evraz Highveld Why have you decided to apply to Evraz Highveld?

Why do you wish to pursue a career in your chosen field of study?

What skills do you have which are most relevant to a career in this particular field?

Your wider skills and competences Describe how you achieved a goal that you set yourself outside academic study:

Please describe your activities and interests outside work experience or academia, listing levels of attainment where applicable:

Please list any IT skills you possess and how competent you are in each of these in the boxes provided below:

References Academic First name: Last name: Address: Email address: Telephone number: Occupation: Relationship to you: Non Academic First name: Last name: Address: Email address: Telephone number: Occupation: Relationship to you:

Additional Information Please give details of any skills/experience/study projects which you think may further support your application:

Employment Equity Race: Black Gender: Male

Coloured

Indian

Female

White