CANDIDATE EMPLOYMENT APPLICATION FORM

SECTION A:

PERSONAL CONSENT AGREEMENT: POPIA Act (Protection of personal information)

The Protection of Personal Information Act 4 of 2013 (POPIA), is South Africa’s data privacy legislation which comes into full force and effect on 01 July 2021.
By signing, completing and reply emailing this employment application and consent form, I hereby confirm that I am responsible for this application, and I am
granting the agency (The Recruitment Guy (Pty) Ltd),

 Permission to process, capture and store my personal information.

 Allowing my personal information to be given to third party operators. This includes the following: prospective employment companies,
agencies, their clients, customers, and relevant administrators and/or additional electronic (on-line) service providers.
 I have the right to deny access to my personal information to be shared by informing the agency in writing (via reply to this email).

Full Names: Ms Mohini Singh ID Number: 8804250111082 Date: 16/01/2023

SPECIAL APPLICATION INSTRUCTIONS:

REF #: TRG 1813
POSITION APPLIED FOR: Frontline Practice Administrator and Patient Co-Ordinator
AREA (REGION) OF VACANCY: Newcastle
ON-LINE ADVERT LINK: http://www.pnet.co.za/5/job.html?&OfferId=3499690&cid=B2C_CLC_SYS8_Listing

SPECIAL INSTRUCTIONS: 1. Urgent completion of this form and return email is required.
2. Please complete ALL sections of this application form.
3. Please complete ALL sections in the tables provided below. Type directly onto this document.
4. Please complete this open word document, save, and return email back in open word format.
5. DO NOT email the application form back in PDF, Scanned, Photo, Photocopied or handwritten
formats as this delays your application process.
6. Please use the above Ref# 1813 when replying.
SECTION B:

CONTACT DETAILS:

Contact Number (Primary) 0729323015

Contact Number (Secondary) 0744954441
When is the best time to contact you? Anytime
Your “daily use” personal email address? singhm88@yahoo.com
Do you have WhatsApp, and can we communicate with Yes 0729323015
you on this channel? (Which number can we use?)
What virtual platforms do you use for interviews? Zoom
Have you applied for this position through another No, yes I do acknowledge and agree for recruitment guy to
agency, company or anyone else? represent me.
If YES, please explain and what is the status of this application?
If NO, do you acknowledge and agree to allow
#TheRecruitmentGuy to represent you with our client from here
forth?
Do you have any other possible employment offers / No
negotiations or opportunities pending? Please explain?
Do you have anything you wish to declare / inform or No
 bring to our attention concerning this application?
(If any) health/medical conditions, criminal record, dismissals etc that
may hinder this employment application?
Should you be shortlisted, will you allow us consent to Yes
complete the following background checks on you?
Medical, ITC, Criminal, References, Educational etc (If required)

PERSONAL INFORMATION:

Full names & surname Mohini Singh

What name do you prefer to be called by? Mohini
South African citizen / Permanent resident / Other South African
Date-Of-Birth 25/04/1988
ID Number 8804250111082
Equity status: (African, Asian, Caucasian, Male, Female other Asian
etc)
Languages (Written & spoken) English
Driver’s licence (with own transport) Yes
What car do you have and what condition is it in? Nissian hard body yes in good condition.
Are you able/willing to travel out of town (if required)? Yes
Current area of residence? Newcastle lennoxton
This vacancy is based in Newcastle.
Why would you consider relocation to Newcastle?
Details and motivation please?

EMPLOYMENT INFORMATION:

The reason why you are seeking new employment? Currently unemployed
Why have you applied?
Current employment status? Unemployed
Employed, unemployed, retrenched, contract, other etc?
(Please explain?)
Current / Last position held? Receptionist
Your position title as per your current/last payslip?
Current / Last salary received? R 8 500
Gross (before deductions) VS Nett. (After deductions)
th
Bonus / 13 Cheque
Please explain if you Bonus
received any additional Commission structure (Explain how it’s calculated)
No
benefits or perks in your Medical aid
No
current/last position? Pension fund
No
Provident fund
Yes
Life Insurance
No
Retention allowance
No
Cell allowance
No
Live-out / Housing allowance
No
Other allowance
No
Transport / Fuel allowance
No
Other allowance
No
Laptop
No
What is your realistic salary expectation for this Frontline R7 500
Practice Administrator and Patient Co-Ordinator vacancy
based in Newcastle?
(Please keep in mind the current local economy situation “Post
Covid”, the advertised salary, the client’s budget within their
specific industry and your current employment situation when
commenting) Our client is offering permanent, stable
employment with a market related monthly salary of +/- R7 000
– R8 000 kpm
How negotiable are you on your expected salary? Able to negotiate
Your resignation / availability to start? Immediately
One month’s notice / calendar month / week / other?
Client prefers the right applicant to start ASAP?

Page | 2 | TRG 1813 (Newcastle) Frontline Practice Administrator and Patient Co-Ordinator
 Interview availability in Newcastle? 1st Interview (on-line) - Immediate
How soon could you attend the following interviews? 2nd Interview (Face to face / On site) – immediate

EDUCATIONAL | EXPERIENCE | SKILLS INFORMATION:

Tertiary education (If any, please list and explain) National Diploma in Hospitality Management
Please confirm all your achieved tertiary qualifications (Degree,
Diploma, Certificates, Trade/Technical or other qualifications and
attach with you reply?
Secondary education 2006
Grade 12 (Matric) Year?
Do you have any Company In-house / Training / Yes, Specsavers frontliner certificate, Hoya optics training.
Certificates or other etc Financial training at One&Only resorts.
Please explain and attach with your reply email?
Do you have any Commercial Software / Programs / In- Calico and Hoya, optimum, Discovery.
house Company Systems or other experience?
Please name and list your software/system experience and
proficiency levels?
Do you have Pastel or similar experience? Yes basic
Your level of computer literacy? Microsoft Office – Advances
Beginner / Intermediate / Advanced? MS Word - Advanced
MS Excel - Advanced
MS PowerPoint - Advanced
Other -
How many years exp. do you have as a Frontline Practice 4years, I have worked for Spec- Savers Mx Boksburg from
Administrator and Patient Co-Ordinator? 2013, I have also work off and on at other franchises.
Please explain?
What industries are you familiar with (have experience I have Hospitality experience from Front office to
in) working as a Frontline Practice Administrator and Administrative duties as well Financial experience.
Patient Co-Ordinator?
Do you have any Optometry industry experience / Yes I have worked closely with my optometrist which
exposure? included checkong spectacles scripts for patients as well as
taking measurements for required scripts.

SECTION C:

DUTIES, ACCOUNTABILITIES & COMPETENCIES

Listed below (as advertised) are the key performances areas and responsibilities required by this position. Please complete the table below
(write a paragraph) by giving the client more clarity with regards to your exposure and experience in relation to these requirements listed
below. Quality thought provoked feedback will ensure your shortlisting and interview invitation. (Yes and No answers will be rejected)

What experience do you have with Co-ordinating patients in a practice? Please elaborate?
 Greet the patient explain to the patient file that needs to be filled in make a copy of the medical aid card as well as the
credentials of the patient.

What type of Administration experience do you have (List what you can do)
 Debtors
 Creditors
 Filing
 Medical Aid payments
 Medical Aid benefit check
 Quotations for the patient explaining Px portion and medical Aid
In your own words, why do you believe you are the right candidate for this position?
 Yes not only do I have the passion I also have the drive to work in the industry, self motivated, and a team player.

EMPLOYMENT HISTORY (REASON FOR LEAVING) & REFERENCE CONSENT FORM:

In order to be considered for this position, we require your permission to complete references on your previous employments. Please
complete the table in full below in the sections provided. We require the full details of your immediate superior at each position ( The
person you reported to, NOT someone else or a random contact at the company you may know). If you had an issue (if any) please record
your story / situation below and we will discuss with you in person first)

Page | 3 | TRG 1813 (Newcastle) Frontline Practice Administrator and Patient Co-Ordinator
 POSITION 1

COMPANY NAME: Spec-Savers Mx Boksburg

YOUR POSITION TITLE: Frontliner and Debtors and Creditors
PERIOD OF EMPLOYMENT: START DATE: 01/2013 END DATE: 12/2015
REASON FOR LEAVING: Relocated
REFEREES NAME: Melani Du Plessis
(Your immediate Supervisor)
REFEREES JOB POSITION/TITLE: Owner/ Director/Franchisee
REFEREES CONTACT NUMBER: OFFICE NUMBER: MOBILE NUMBER: 083 384 5170
REFEREES EMAIL: melani.duplessis@specstores.co.za
POSITION 2

COMPANY NAME: Lennoxton Primary School

YOUR POSITION TITLE: Teachers Assistant

PERIOD OF EMPLOYMENT: START DATE: 26/10/2021 END DATE: 31/03/2022
REASON FOR LEAVING: Contract ended
REFEREES NAME: Mr Dawood
(Your immediate Supervisor)
REFEREES JOB POSITION/TITLE: Dept principal
REFEREES CONTACT NUMBER: OFFICE NUMBER: 03431 71223 MOBILE NUMBER:
REFEREES EMAIL: Lennoxtonprimary@telkomsa.net
POSITION 3

COMPANY NAME: Enigma lifestyle apartments

YOUR POSITION TITLE: Receptionist
PERIOD OF EMPLOYMENT: START DATE: 9th Aug 2018 END DATE: 9 Jan 2019
REASON FOR LEAVING: Leadership Ended
REFEREES NAME: Chris Krost
(Your immediate Supervisor)
REFEREES JOB POSITION/TITLE: Manager
REFEREES CONTACT NUMBER: OFFICE NUMBER: 082 494 5726 MOBILE NUMBER:
REFEREES EMAIL: Chad@limestone.co.za
POSITION 4

COMPANY NAME: One&Only Resorts

YOUR POSITION TITLE: Receptionist
PERIOD OF EMPLOYMENT: START DATE: 24th July 2017 END DATE: 29th September 2017
REASON FOR LEAVING: Leadership ended
REFEREES NAME: Ryan Ferreira
(Your immediate Supervisor)
REFEREES JOB POSITION/TITLE: Manager
REFEREES CONTACT NUMBER: OFFICE NUMBER: 021 431 5888 MOBILE NUMBER:
REFEREES EMAIL: Ryan.ferrira@oneandonlycapetown.com

Please enhance your employment application submission by attaching the following documents with your reply:

1. ID Copy.
2. Driver’s / (Other) / Operating licences.
3. Secondary (Grade 12) & Tertiary Qualifications (If any).
4. Any additional certificates and training certificates achieved.
5. Previous payslips (required to verify and qualify your earnings) – Private & Confidential.
6. (If any) previous written references that you have obtained from previous/past employments.
7. (If any) criminal records / grievances / credit judgement / fraud reports etc

Please ensure you complete all the Sections of this application.

We appreciate your application and the invested effort to complete this application form in its entirety. We endeavoured to simplify the process as best as
possible (in accordance with the POPIA Act and the clients mandate).

Please save this Word.Doc and return email it in “open” word format for our attention. (Not in PDF, Scanned, Photo, Photocopied or handwritten formats as
this delays your application process.

Once received, your data will be uploaded onto our recruitment system and captured under your candidate profile.

We invite you to connect with us on the following platforms.

Facebook: www.facebook.com/therecruitmentguy
LinkedIn: www.linkedin.com/markbstaples
Twitter: @GuyRecruitment
Instagram: The_recruitment_guy

Page | 4 | TRG 1813 (Newcastle) Frontline Practice Administrator and Patient Co-Ordinator
Thank you | Ngiyabonga | Dankie
Recruitment regards.
The Recruitment Guy (Pty) Ltd

Page | 5 | TRG 1813 (Newcastle) Frontline Practice Administrator and Patient Co-Ordinator