MEP Application Form - Message South Africa

Your Information

What is your full name?

First

Last

Date of Application

Required Documentation

Upload your Parole Conditions Here

Maximum file size: 516MB

Upload a copy of your ID here

Maximum file size: 516MB

Upload a copy of your CV here (If you have)

Maximum file size: 516MB

Upload any additional certificates (Education, qualifications etc.)

Maximum file size: 516MB

Personal Information

Name

First

Last

Your preferred name

Do you have an ID Book/Card?

Yes

No

I am not a South African Citizen

ID Number

What is your current age?

Date of Birth

Address

City

State/Province

Zip/Postal

Country

Your Contact Number

What is your first preferred language?

English

Afrikaans

Xhosa

OtherOther

What is your English Reading Ability?

Very Well

Average

Low

What is your highest level of Education?

Do you have a driving license?

Yes

No

What is your religion? What is your religion?

If Christian, what church do you beling to?

What is the name of the church contact person?

First

Last

What is their contact number?

Do you have a criminal record?

Yes

No

Family Contact Information

Family Contact Name

First

Last

Phone

What is your relationship to this person?

If you have a criminal record, please complete this section

Crime #1

Length of sentence #1

Crime #2

Length of sentence #2

Crime #3

Length of sentence #3

Please list any additional crimes and sentances in the space provided below

Were you involved in a Gang?

Yes

No

If yes, what Gang?

Please upload your pole conditions here

Maximum file size: 516MB

Date of last incarceration

When were you released?

Are you currently on parole?

Yes

No

Date your Parole started

Parole Officers Name

First

Last

Community Corrections Department

Cape Town

Bellville

Mitchell’s Plain

OtherOther

Prison Number

Health/Addictions

Do you have any Health concerns? If so please describe

What is your addiction? Please explain

Did you seek help from others? If so, who?

Was your family aware of your addiction? Please Explain

Is there anything else you would like to share related to your addiction?

Family Information

Describe your relationship with your Mother?

Describe your relationship with your Father?

Describe your relationship with other family members? (Siblings & Grandparents etc.)

How do you feel about your family?

Skills and Work Experience

Restoratove Justice

Date

With who

Contact Person

VOD (Meet your Victim)

Date

With who

Contact Person

Alpha Course

Date

With who

Contact Person

Sports

Social Services

With who

Contact Person

Social Services/Mental Health Professional

Date

With who

Contact Person

Bible Studies

Date

With who

Contact Person

Do you have a SARS number?

Yes

No

Have you worked before?

Yes

No

Do you have a CV?

Yes

No

Who did you work for? Include contact details.

Please explain the work you did.

Do you have a mentor?

Yes

No

Name of Mentor

If not, would you like a mentor?

Yes

No

What type of mentor would you lile?

Discipleship Mentor

Biblical Mentor

Additional Information

Please tell us your vision for your life (your dreams – what you want to do in the future?)

What are your current goals?

What have you done to achieve this goal?

Why do you want to be part of the Message Enterprise Programme?

What value will you add to the Program?

What motivates you and how will you make a positive difference in South Africa?

Any other information that you would like us to know?

Message Enterprise Program (MEP) Applications

Your Information

Required Documentation

Personal Information

Family Contact Information

If you have a criminal record, please complete this section

Health/Addictions

Family Information

Skills and Work Experience

Additional Information