FORM 3

APPENDIX A

APPLICATION BY A FORMER MEMBER OF THE AGENCY AGAINST A DECISION OF THE DIRECTOR-GENERAL

Application in terms of section 28 of the Act, read with Chapter XXIV

A former member of the Agency may appeal to the Minister against a decision of the Director-General not to provide him or her with a clearance certificate to enter employment in the private security industry.

The former member must complete this form and send it to the Director-General:

Complete this form in full. If you need more space to answer the questions then complete your answers on another sheet of paper and attach it to this form.

1.

Personal information

1.1

Name

1.2

Employee number

1.3

Address

1.4

Tel number (h)

1.5

Tel number (w)

1.6

Cell number

1.7

Fax number

2.

Employment history with the Agency

2.1

Name of employer

2.2

Directorate/Division/Unit

2.3

Occupational group

2.4

Highest post level attained

2.5

Name of immediate supervisor

2.6

Period of employment

3.

The grounds for the appeal

Specify in your answers to these questions in what respects you disagree with the Director-General's decision.

3.1

Did the Director-General, in your opinion, fail to consider or gave insufficient weight to relevant factors?

3.2

Did the Director-General, in your opinion, consider or give weight to irrelevant factors?

3.3

Did the Director-General, in your opinion, make any error of law?

3.4

What outcome/result do you seek from this appeal?

3.5

Are there any other factual or legal grounds you wish to draw to the attention of the Minister?

4.

Further information

4.1

The Director-General will forward all relevant documentation to the Minister and to you within twenty (20) days of receipt of this appeal.

4.2

You may supplement your grounds to appeal within ten (10) days of receiving this documentation.

Applicant's signature                                                                      

Date