For your information: (Please read before continuing)



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For your information: (Please read before continuing)

You can submit the fully completed application packet with express mail to our office in Paarl:


Earn Abroad
P.O. Box 6249
Main Street
Paarl, 7622
Phone: 084-506-5959
http://www.golden-opportunities.us
It is strongly recommended that you save the document before you submit it in case the e-mail does not go through. It is also your responsibility to check with the office if the application was received. Please make sure that all scanned documents are clear and readable.
Greetings,
Magda Swart
Earn Abroad
lease fill in the Application and Resume below with your information. You can save or print the form when you are done. You can then either attach it to an e-mail and e-mail to grippon@global.co.za or fax it to 086-502-5380. Please keep a copy on your computer or in your possession until you have verified that the agent received the application.

EMPLOYEE APPLICATION

NEAREST / PREFERABLE CONSULATE: Please mark

Cape Town  Johannesburg  Natal  Namibia 



PERSONAL INFORMATION:

Nick Name:

     


Last Name (Surname):

     


First Name:

     


Middle Name:

     


Date of Birth:

     



Age:

     


Place of Birth:

     


Nationality:
     

Social Security Number: (If applicable)

     


Identification Number:
     

Passport Number:
     

Passport issued: (mm/dd/yy)

     


Valid until:

(mm/dd/yy)

     


Place of Issuance:
     

Province:
     

Have you ever applied for a visa in the USA?
Yes  No 

If yes, What type of Visa?
     

Where?

     


Date:

     


Have you ever been denies a visa?
Yes  No 

When? Stipulate Reason.

     


Have you ever worked in the USA?
Yes  No 

If yes, when?
     

RELATED INFORMATION:

Do You Smoke? Yes  No 
How many a day do you smoke?      

Do you consume alcohol? Yes  No 

If yes, How many a day?      

How many a week?      

Have you ever used drugs? Yes  No 

Have you ever been charged with driving intoxicated in the last two years?

Yes  No 



Do you have any Criminal Offenses? Yes  No 

If yes, explain:      



Have you had any traffic violations in the past 2 years? Yes  No 

If yes, explain:      



FAMILY INFORMATION: Please provide contact information in case of an emergency.

Marital Status:

Married:  Single:  Divorced:  Separated: 



If married, Wife’s name and maiden name:      

Name:      

Maiden Name:      

Wife’s Telephone Number:

     


Address:

     


Wife’s Mobile (Cell) Number:

     


Both Parents Names:
Father:      

Mother:      



Parents Telephone Number:

     


Address:

     


Parents Mobile (Cell) Number:

     


I,       hereby declare that the above information is correct.

RESUME





PERSONAL INFORMATION:

First Name:

     


Middle Name:

     


Last Name (Surname):

     


Current Address:

     


P.O. Box (if applicable):

     


Daytime Phone:

     



Mobile Phone:

     



Fax Number:

     



E-mail Address:

     


DRIVERS LICENSE CODE: (PLEASE CHECK)

Code 8  Code 10 Code 14 CDL


CDL License number (if any):      


Expiration Date:      

EDUCATION:

High School Name:

     


Grade Completed:      

Year Obtained:      


College/University (if any):

     


Degree:      

Year Obtained:      


LANGUAGE SKILLS:

English Speaking and Listening:
Excellent Good Fair Poor


English Reading and Writing:
Excellent Good Fair Poor




EMPLOYEMENT INTERESTS:

Please select all job categories you are interested in. Please remember the more you select the better chance you have of getting a job offer. Certain categories are season and depends on season you are in. Check all that apply.

Grain Harvesting / Graan Cattle / Beeste


Cotton Harvesting / Katoen General Farming / Alg. Boerdery
Silage Harvesting / Hooi  Mechanic
Crop Farming Mills / Meule (Honde Kos)
Semi- Driver / Trokdrywer (Stroop) Fencing / Omheinings
Pecan / Peukaneut Milking Parlor / Merkery
Mink Farms / Mink Plaase Irrigation / Besproeing
Hog Farm / Vark Plaas Seed Company / Saad Maatskappy
Bee Keeper / Bye Plaas Other / Ander

EMPLOYEMENT HISTORY:

Employer 1

Company Name:      
Address:      
Country where company is located:      
Phone:      
Supervisor Name:      
Job Title:      
Reason for Leaving:      
Dates of Employment: From:       To:      
Job Description/Responsibilities:      


Employer 2 (if any)

Company Name:      
Address:      
Country where company is located:      
Phone:      
Supervisor Name:      
Job Title:      
Reason for Leaving:      
Dates of Employment: From:       To:      
Job Description/Responsibilities:      


ABOUT MYSELF:

Please tell us about yourself, any farming or other related experience. Please also include any information you might think is relevant to the position you are applying for:



     

REFERENCES:

Please provide the name and phone number of two professional references who are not related to you. This may or may not include previous employers. There are the names of people you want the employer to contact if they so desire.



Name:      

Phone:      

Name:      

Phone:      

ADDITIONAL INFORMATION:

If you are interested to apply, make sure that you send the following documentation to go with this document.
1. A color Photo

2. This completed Employee Application, Resume, checklist, and health declaration form.

3. A Signed declaration of payment terms (will be given to you by the agent)

4. Copy of your High school diploma and other diplomas that might be relevant

5. Copy of your Passport, ID document, and Drivers License (SA / CDL)

6. International Driver's License. This can be given after the consulate appointment.

7. Proof of deposit made for fees agreed upon.


Drug Testing:
I understand that all prospective employees/current employees can be submitted to a controlled substance test. A urine specimen will be collected at a site selected by the Company and tested for controlled substances at a certified laboratory. I understand that if I decline to sign this consent and thereby decline to take the test or fail the test when taken, employment will be terminated immediately and employee will be send back to South Africa at their own expense. If selected to be tested for a controlled substance and the test is verified as positive, I will be considered unqualified for employment and the company will have the right to terminate my employment. By typing/signing your name in the box below you agree that you have read these terms and you are willing to be tested before or during employment, upon the request of the company.


Alcohol Abuse:
Alcohol abuse will not be tolerated on the job or if it influences your ability on the job. The laws in the United States are very strict when it comes to alcohol related crimes. It is illegal to drink if you are under the legal drinking age. The legal drinking age in the United State is 21. If you buy for a minor or if you drink as a minor it is considered against the law and could result in fines and in some cases jail time. If you receive a DUI (driving under the influence, you license will be taken away and in some cases you could receive some jail time. This will be considered as grounds for termination. All the jobs offered need a valid license, if you lose your license you will not be able to complete the job. If you abuse alcohol and it interferes with your job, your employer has the right to terminate your employment and send you back to South Africa at your own expense. If you violate this, the agent will not help you in finding a different job, you will have to go back to South Africa. Please be responsible! By typing/ signing your name in the box below you agree that you have read these terms and you agree to them.


I do agree that everything I have submitted in this document to its entirety is truthful. Golden Opportunities and its agents cannot be held responsible if the information you submitted is incorrect or false. Please make sure that all the information you have provided is correct. By typing/signing your name below, you agree that your information is correct and that you will solely be held responsible for any false information.
Name:      
Date:      

Checklist: Skills and Abilities

Seasonal farm work



APPLICANT NAME:      

FIELD EQUIPMENT: No Some Good

Skid Steer Loader

Klein Laaigraaf







Large Field Tractor

Groot Dubbel Wiel Trekker







4-WD Tractor

4 Wiel Aangedrewe Trekker – Groot dubbel Wiel







Articulating Tractor

Knak in die middle op spilpunt voor & after wiele







Air Drill Planter / Seeder

Planter met baie pype wat met lugdruk plant







ATV 4 Wheeler with spot Sprayer

4 Wiel motorfiets met spreier agter.







Chisel Plow

Bytel ploeg







Chore Tractor

Algemene diens trekker soos bv. Ford 4000







Combine, small

Klein stroper







Combine 25 foot head flex

Groot stroper







Combine 25 foot head straight

Groot stroper







Combine 30 foot head flex

Groot Stroper







Combine 30 foot head straight

Groot stroper







Combine 42 foot head flex

Groot stroper







Combine 42 foot head straight

Groot stroper







Cultivator

Skoffel Ploeg







Planter

Planter







Spreader

Rondstrooier







Swath / Swather

Ry gooier – self aangedrewe hooihark







Sickle mower

Sekel snyer







Rotary mower

Lem snyer funksie is ratkas aangedrewe







Land roller

Roller wat agter trekker gehak word om grond vas te rol







Harrow – 50 foot heavy harrow

50 voet eg







Hay baler

Hooi baler







Forage Chopper

Kuilvoer masjien







Tandem

Disk ploeg







Grain Cart

Gestroopte gewasse van stroper af in wa pomp







Moldboard plow

Skaar ploeg, waar die skare vas is aan ploeg bord







Stone picker

Klippe optel in die lande – werk soos aartappel uithaler







Row crop cultivator

Skoffel ploeg







Row crop planter

Ry planter







Track driven tractor (like CAT)

Trekker met rusperbande – ander bestuurs tegniek







Wheel Rake

Algemene wiel hark om hooi / gras in rye te hark







Windrower – 25 foot – pull type

Hooi hark wat 2 rye hooi / gras op 1 ry hark








APPLICANT NAME:     
CROP RELATED SKILLS: No Some Good

Crop Spraying knowledge

Monitor van gewas bespuiting







Computerized instrument panel

Kennis van gerankenardiseerde bespuitings toerusting







Calibrate Sprayers

Kennis van gewas bespuiting procedures en kalibrasie







Driving self propelled cropsprayer

Gewas spreier met groot hoe wiele







Planting operations & procedures

Kennis van saai – gewas aanplanting







Tilling Operations

Voorbereidings procedure vir plant van gewasse








FORAGE EQUIPMENT: No Some Good

Forage Chopper

Kuilvoer masjien







Forage Preservation

Maak van kuilvoer







Drive a pickup

Gewone bakkie







Drive any size car










Drive a ¼ ton vehicle










Drive a ½ ton vehicle










Drive a 1 ton vehicle










Drive a 2.5 ton vehicle










Drive a semi truck & trailer

Commercial Drivers License (CDL) – Kode 14







Drive a semi truck with two trailers

Commercial Drivers License (CDL) – Kode 14







Mower / conditioner

Snymasjien







Round baler – big

Maak van ronde bale wat 6 voet hoog staan







Silage blower

Voer geoesde gewas uit pyp – sleepwa na silo







Silage wagon

Spesifieke sleepwa wat kuilvoer vervoer







Square baler

Gewone baal masjien







Stack maker

Stapel gewone & ronde bale op ‘n hoop







Square bale - big

Maak groot bale – 4 klein bale maak 1 groote








DAIRY SKILLS : No Some Good

Parlor milking

Melk koeie met outomatiese melkmasjiene







Milk in stall barns

Melk op ou metode met die hand







Parlor Practice

Kennis van voer en melk-stal procedure







Changing clusters

Die omruil en hantering van suigbuise aan spene







Take sterile samples

Neem steriele toets monsters







Diagnose and treat mastitis

Diagnosering & behandeling van mastitis







Artificial Insemination

Kunsmatige inseminasie







Vaccinations

Inenting







Clipping / Torch udder

Skeer / skroei van koeie se uier-hare







Stanchions

Kennis insluit-voertroe/drukgange voer & melkstal








APPLICANT NAME:     
LIVESTOCK SKILLS(Cattle): No Some Good

Artificial Insemination

Kunsmatige Insemination







Vaccination

Inentings







Castration – band method

Kastreer met rekkies







Castration remove / cut method

Kastreer deur te sny en verwyder







Dehorning

Knip en brand van horings







Experience – Calf Jack /Breach

Help met die geboorte van ‘n brug kalf







Deliver normal calf

Normale geboorte bystand







Feeding cows and calves

Voer koeie en kalwers







De-worming

Ontwurmings middle toedien







Hoof trimming

Knip van diere hoewe







Detect ketosis

Die identifisering van die metaboliese wanbalans







Detect milk fever

Om melk-koors betyds te diagnoseer en behandel







Detect twisted stomach (DA)

Onstelde maagsiekte – Displaced abonasum







Diagnose / treat scours

Diagnoseer siektes agv mikrobiologiese organisms







Use of a balling gun

Vir die toedien van pille/tablette aan beeste







Dry cow feed program

Kennis van voiding programme vir die droe koeie








LIVESTOCK SKILLS (Hogs / Breeding): No Some Good

Artificial Insemination

Kunsmatige Inseminasie







Vaccination

Inentings







Castration – band method

Kastreer met rekkies







Castration remove / cut method

Kastreer deur te sny & verwyder







Feeding

Voeding







Power washing










Pregnancy / Gestation checking

Dragtigheids-bepalings toets







Record keeping (Heard)

Rekordhouding







Weaning

Speen







Heat synchronization

Hitte sinkronisasie







Implant embryo

Die implanting van embrio’s







Select mating for cows

Die uitkies van korrekte teel pare







Maintain daily logs

Rekordhouding van daaglikse incident rapporte







Herd health records

Organiseer, datum van kudde gesondheids records







Read DHIA reports

Interpretasie van DHI Assosiasie verslae







Read pedigree

Stamboek ontleding







Understand ration printout

Kennis van voer porsies en voermengsel beginsels








APPLICANT NAME:      

LIVESTOCK SKILLS (Feeding Equipment): No Some Good

Operate & Service Conveyor

Hantering & onderhoud van vervoerband







Service top silo un-loader

Diens silo pomptoerusting







Calibrate mix-mill

Kalibrasie van voermengsels







Automatic feed bunk

Gebruik van ge-outomatiseerde voedings banke







Computer feeder

Gerekenardiseerde voedings mengsel toerusting







Electronic scales

Gebruik van elektroniese skale







Grinder mixer

Gebruik van meule mengers







Run TMR mixer

Voer menger meule – sleep agter trekker








MECHANICAL SKILLS: No Some Good

Maintenance combine

Onderhoud van stropers







Maintenance 4-WD tractors

Onderhoud van 4-wiel aangedrewe trekkers







Maintenance large field tractors

Onderhoud van ekstra groot trekkers







Maintenance pickups

Onderhoud van bakkies







Maintenance track driven tractors

Onderhoud van rusper-band tipe trekkers







Overhaul diesel engines

Die oorbou en re-condition van diesel engines







Overhaul gas engines

Die oorbou en re-condition van petrol engines







Repair 4-WD tractors

Herstel van groot tipe 4x4 trekkers







Repair Chore tractors

Herstel van normale algemene diens trekkers







Repair Combine

Herstel van stropers







Repair Diesel/Gas/tractor engines

Herstel van diesel, petrol en groot engines.








OTHER SKILLS: No Some Good

Fencing

Oprigting van draadheinings







Welding

Sweis







Arc/ Gas/ Plasma Welding

Gevorderde sweiswerk







Electrician

Elektrisiteit







Boiler maker

Ketelmaker







Operate a fork lift

Bestuur en hantering van vurk-hyser







Irrigation: Pivot/ Flood/ Sprinklers/ Micro

Besproeiing: Pivot / Vloed/ Sprinkels/ Micro







Other: Farrier work










General Horse work











APPLICANT NAME:       DATE:      
HEALT DECLARATION:

Applicant Name:      

To be completed by ALL applicants together with your applicant profile.


Weight (lbs)

     

Height (ft & in)

     

Kilogram na pond – X met 2.205


Meter na voet – X met 3.281
Are you currently suffering from or have ever suffered from any of the following illnesses / disorders? Place an X in the appropriate box.



YES


NO

Any disorder of the Heart?






High blood pressure or disease of the blood vessels or circulatory disorder?








Any respiratory or lung trouble?








Any disorder of the digestive system, gall bladder or liver?








Any nervous or mental complaint, e.g. epilepsy, blackouts, paralysis?

Any anxiety or depression?






Diabetes







Any physical abnormality, deformity, handicap, or defect?








Any form of severe allergy, such as asthma, sinusitis, hay-fever, etc.








Consulted a doctor for any reason in the last year?








Are you on any form of medication?














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