BUSINESS CONNEXION APPLICATION FORM INTERNSHIP PROGRAMME: 2012 PLEASE INDICATE YOUR PREFERRED LOCATION AND AREA OF SPECIALIZATION AS FOLLOWS: *1= FIRST PREFERRENCE, 2 = SECOND PREFERENCE AND 3 = THIRD PREFERNCE
Western Cape (Cape Town) KwaZuluNatal Eastern Cape (East London) Gauteng (Johannesburg, Midrand, Pretoria) Mpumalanga (Nelspruit, Middleburg) Eastern Cape (Port Elizabeth) Limpopo (Polokwane)
PERSONAL DETAILS: Title: Surname: Full Names: Preferred Name: Race:
AFRICAN
Gender
MALE
FEMALE
YES
NO
WHITE
ASIAN
COLOURED
Identity Number: Date of Birth: Disability If Yes, State the nature of disability Driver’s License
YES
Home Language:
CODE
NO
Other Language:
CONTACT DETAILS: Cell phone number: Other Contact number:
Code:
Number:
Email: Physical Address: POSTAL CODE: Postal Address: POSTAL CODE:
Service Management
Bid Administration
Engineering
Administration
ICT Asset Management
Support/Admin Support
Project Management
Networking
Sales
Human Resources
Preferred Location
Business Analyst
Development
NB: ONLY MAKE A SELECTION ON THE UNSHADED BLOCKS
QUALIFICATIONS: NAME OF SCHOOL
HIGHEST QUALIFICATION OBTAINED
YEAR OBTAINED
SUBJECTS AND SYMBOLS
HIGHEST QUALIFICATION OBTAINED
YEAR OBTAINED
MAJOR SUBJECTS
TERTIARY EDUCATION NAME OF INSTITUTION
OTHER TRAINING COURSES ATTENDED COURSE/TRAINING
INSTITUTE/COMPANY
YEAR COMPLETED
HAVE YOU EVER PARTICIPATED IN ANY LEARNERSHIP/INTERNSHIP? YES
NO
If Yes, Please provide details: COMPANY/INSTITUTION
TITLE OF LEARNERSHIP/INTERNSHIP
DURATION
START DATE
WORK EXPERIENCE, IF ANY: EMPLOYER
POSITION HELD
FROM
TO
REASON FOR LEAVING
END DATE
BRIEFLY MOTIVATE, WHY YOU SHOULD BE SELECTED TO PARTICIPATE IN THE INTERNSHIP PROGRAMME:
SIGNATURE OF APPLICANT
DATE
SIGNATURE OF LEGAL GUARDIAN (IF APPLICANT IS YOUNGER THAN 18 YEARS)
DATE
IMPORTANT NOTES:
Failure to complete the application form in full and correctly may prejudice the applicant’s chances of being selected to participate in the internship Closing Date: 10 October 2011 Submit your application to: internship2012@bcx.co.za or Fax: 086 592 1083