FORM 2

APPENDIX A

APPLICATION BY A FORMER MEMBER OF THE AGENCY FOR A CLEARANCE CERTIFICATE

Application in terms of section 28 of the Act, read with Chapter XXIV

A former member of the Agency may apply to the Director-General for a clearance certificate to enter employment in the private security industry. The former member must complete this form and send it to the Director-General:

Complete this form in full. If you need more space to answer the questions then complete your answers on another sheet of paper and attach it to this form.

1.

Personal information

1.1

Name

1.2

Employee number

1.3

Address

1.4

Tel number (h)

1.5

Tel number (w)

1.6

Cell number

1.7

Fax number

2.

Employment history with the Agency

2.1

Name of employer

2.2

Directorate/Division/Unit

2.3

Occupational group

2.4

Highest post level attained

2.5

Name of immediate supervisor

2.6

Date of commencement of employment

2.7

Date of termination of employment

3.

Nature of proposed services in the private security industry

3.1

What type of services will you be expected to render:

3.2

What skills, knowledge or information that you gained while in the Agency will be utilised?

4.

New employer/proposed business details

If you will be employed in the private security industry,  complete questions 4.1 and 4.2.  If you plan to start your own business in the private security industry, complete questions 4.3 and 4.4.

4.1

Who is your proposed new employer?

4.1.1

Name

4.1.2

Address

4.1.3

Tel number

4.1.4

Fax number

4.2

Who are your proposed new employer's clients (i.e. to whom will your services be provided)?

4.3

What are your business details?

3.5

How do you intend to disclose the information?

4.

Further details

Is there any other information you wish to draw to the Reveiew Board's attention?

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