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(A) Company Details (“The Company”) To be completed by Company Agent – PLEASE PRINT
Personal Credential Verification
Permission and Indemnity Declaration
Company Name:
Western Cape Education Department Email:
Branch Name:
Recruitment and Selection Phone:
(B) Checks Required
Identity Checks Academic Qualifications Enatis Checks
Yimi Matric Pre 92 Umalusi Driver's Licence
ID Verification Matric Post 92 Umalusi Professional Driving
Permit Citizenship Verification South Africa Qualification Vehicle Information
SA Work Permit N-Levels Title Holder Information
Asylum Permit Global
Qualification Bank Account Verification
Credit Checks Employment Checks Criminal Checks
Transunion Credit Fit & Proper Fraud Listing
Compuscan Credit FAIS Comprehensive Criminal Record Check
Experian Credit Professional Associations
XDS Credit Social Media Check
Do you have any previous Charges
Yes No If yes, please list:
Bureau ID
Verification Agent
Name:
NOTE:
Required: Please select reason code from the list below
Bureau
Comprehensive
Bureau Notices
** 1. Employment in a position that requires trust and honesty and entails the handling of cash or finances
2. Verifying educational qualifications and employment
3. Fraud detection and fraud prevention services
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(C) Personal Information
Surname: Maiden Name:
Full First Names: Date of Birth:
Primary ID No: 2nd ID / Passport: Permit Number:
Res. Address:
Code:
(D) Qualification To be completed by Candidate – PLEASE
PRINT
Information
(1) (2) (3) ()
Qualification:
Institution / School:
Province / Address:
Date Obtained:
Student No:
Certificate No:
Exam No:
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(E) Indemnity Declaration To be completed by Candidate – SIGN and DATE
I hereby authorize the Company’s duly authorized verification agent, Dots Africa, to forward any personal
information as well as any information that I have provided in support of my application to verification information
suppliers acting on behalf of Dots360 (including but not limited to the South African Police Services/Ideco, the
Government of the RSA, and any educational, training, credit bureau and fraud prevention organizations) for
the purpose of verifying my personal credentials and records. Authorized credential verification types include, but
are not limited to, educational qualifications, professional membership, employment history, employment
references, consumer credit, criminal record, drivers’ license and fraud prevention checks. I authorize Dots360‘s
verification information suppliers to furnish information regarding my credentials, whether claimed or not, to
Dots360 and the Company. I unconditionally indemnify Dots360 and its verification information suppliers against
any liability that may result from furnishing information in this regard. I understand that it is a condition of
Dots360’s verification information suppliers that this information is furnished by them solely for the purposes of
my proposed
/ continuation of employment via the offices of the Company and that any information that is furnished to the
Company and Dots360 will be disclosed to me before a decision is made on my continued employment or
application for employment. Furthermore, I authorize Dots360 to host my fingerprints and, upon request and with
my consent, to release criminal results to other organisations.
Personal Information” shall have the meaning ascribed to it in Chapter 1 of POPI and includes, but is not limited to a
name, address, email address, telephone or fax number, criminal history and education or other personal
credentials provided, or which is collected from the candidate or other third parties, before and/or during the
background screening process and/or thereafter;
I understand that verification requests form part of the background screening process and: Data obtained from the
FSCA serve only for the purpose to determine the fitness and propriety as envisaged in the FAIS Act.
I acknowledge that any Personal Information supplied to the Company is provided voluntarily and that the
Company may not be able to comply with its obligations if the correct Personal Information is not supplied to
the Company.
Personal Information may be shared by the Verification Information Suppliers with Dots360 and be further
stored and shared by Dots360 with the Company
Personal Information may be stored for a reasonable period by the Company, Dots360 and/or the Verification
Information Suppliers, and I take note that if the Responsible Party has utilised the Personal Information contrary to
the Privacy and Data Protection Conditions, I may first resolve any concerns with that Responsible Party. If I am
not satisfied with such process, I have the right to lodge a complaint with the Information Regulator.
A copy of Personal Information kept by the Responsible Parties will be furnished to me upon request in terms of
the provisions of POPI or the NCA and I understand that I may dispute any information in the record provided.
I agree to indemnify the Responsible Parties, and Verification Information Suppliers, acting in good faith in taking
all reasonable steps to process my Personal Information lawfully, against any liability that may result from the
processing of my Personal Information. Provided, however, that this indemnity shall be of no force and effect in
the event that my Personal Information is dealt with negligently or for any purpose for which it was not intended in
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terms hereof
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Candidate Signature DD MM CCYY
As the enquiring Agent of the Company, and in the case that this form instructs Dots360 to provide consumer credit information, I he
Regulations made in terms of the Act, section 18(4) and (5).
AGENT SIGNATURE DD MM CCYY
All signatories to this document agree that Dots360 will NOT be held liable for the content, factual correctness or accuracy of any Supp
failing to communicate information to the Company
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