SECTION A: PERSONAL INFORMATION

Upload Passport Photo: Passport Photo Preview

Upload Documents (CV, Certificates):

Prefix: First/Middle Name(s): Surname: Date of Birth: Gender: Male Female Other Nationality: Current Country of Residence: ID/Passport Number: Phone Number(s): Email Address: Home Address: City/Town: Postal Code:

SECTION B: EMPLOYMENT DETAILS

Position: Coordinator Researcher Research Fellow Administrative Staff Support Staff Volunteer Other: Employment Type: Full-Time Part-Time Volunteer Department: Start Date: Line-command/Manager:

SECTION C: EDUCATIONAL BACKGROUND

Highest Level of Education: High School Diploma Bachelor’s Degree Master’s Degree Doctorate Other: Institution Name: Field of Study: Year of Graduation(s):

SECTION D: PROFESSIONAL EXPERIENCE

Organisation Name: Position Held: Duration: Responsibilities: Skills and Competencies:

SECTION E: EMERGENCY CONTACT INFORMATION

Full Name: Relationship: Phone Number(s): Email Address: Address:

SECTION F: DECLARATION

I, the undersigned, declare that the information provided above is accurate and complete to the best of my knowledge.

Signature: Date:

For Official Use Only

Received By: Date Received: Verified By: Date Verified:

Notes:

Attach a recent passport-size photograph.
Provide copies of relevant certificates and identification documents.

ACIPS: African Centre for Intangible Phenomena Studies
Phone: +27 76 190 2650
Email: ntombimabindisa@acipssa.org.za / acips.sa@gmail.com
Website: ACIPS Staff Portal