BURSARIES AND GRADUATEAPPLICATION FORM

Application period 1 September to 30 November

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State the reason for your applicationInternship(Workplace experience post qualification for a year in the country of your origin)

Bursary(Financial assistance to complete studies with the opportunity of part-time work or internship)

For bursary applications: Name of degree

Year of study (1st, 2nd or 3rd)

Course cost

Accommodation cost

Period bursary required

For internships Name of degree

Year of study (1st, 2nd or 3rd)

Date of qualification

In-service Training Diploma name

P1 or P2 or both

Do you aim to study further? Please state the course

1. APPLICATION FORM

2. PERSONAL INFORMATIONFull name

Contact address

Contact telephone number(s) Cell:

Landline:

South African citizen Yes No

If not, state country of origin

State country where you would like to obtain an internship

Computer skills Level of competence:

List computer programs used and experience, e.g. Windows, MSWord, Excel, PowerPoint, Accounting, Internet, Email, Acrobat, etc.

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3. EDUCATION HISTORY

4. EMPLOYMENT HISTORY

Name of Secondary school:

Subjects in Grade 12:

Name of University:(If currently at university)

Highest qualification:

Subjects completed:

Please give two or three employer or personal references if possible

Company Contact person Address Telephone number

a

b

c

Please indicate why you should be considered for any of the offerings TOTAL is providing

DECLARATION

I declare that the information I have written on this application form is true and complete. I hereby grant the company permissionto follow up on my references and to do whatever checks might be deemed necessary.

Signature Date

Head Office3 Biermann Avenue, Rosebank, 2196,

Johannesburg, South AfricaHead Office: +27 (0) 11 778 2000

National Customer Contact Centre:0860 111 111www.total.co.za

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