Reference #

4857531 / 101RCT





First Name


Last Name

Address 1

Address 2

Tyntyla Avenue




Rhondda, Cynon, 

Post Code



Email Address

Job reference number

Please read the Job Description carefully before providing information in this Section of the Application Form. Give details of your previous employment or experience which you think would help you to do this job

I am already a PCA with this company and I'm a trained chef.
I am IOSH, BLS & Defibrillator and First Aid trained, I know all about Safeguarding Adults and Children, Data Protection, Fire Safety, Equality and Diversity,

What qualities do you think are important when working as a personal assistant with a disabled person?

I have a lot patience and 1 years experience, I also have a positive attitude and outlook, I am approachable and a very good listener, I am kind and understanding, I have experienced and I'm not afraid of getting my hands dirty, I am already a PCA which I love as it's helping other people.

How do you think you can contribute towards the needs and the independence of a disabled person?

Quality of life, Encouragement, Interaction, Communication, Confidence, Pride, Independence.

What is it about PA work which appeals to you?

I love helping people, I feel like I make a difference and enhance every day to day living.

What are your hobbies/interests?

I love shopping and being out and about, I like taking long walks with my dog, I like swimming, reading and spending time with my family.

Would you consider a casual position if you are unsuccessful with this job?


Do you drive?


Are you a vehicle owner?


Do you smoke?


Are you able to undertake training?


What days/nights are you able to work, or prefer to work?

I can do a few days and most nights.

Are there any circumstances which would prevent you from providing cover or swapping a shift?


Would you like to expand on the answers given above? Please use the box below.

I have a main job as a chef of 25hrs a week but I can work on my days off, I work 8hrs extra a week as a PCA in my home town but I flexible as to working evenings.





In what capacity do you know this person (should not be a family member)?





In what capacity do you know this person (should not be a family member)?

Rehabilitation of Offenders Act 1975 * Within the nature of the work for which you are applying this position is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1975 (Exemptions Order). Applicants are therefore not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of this Act. In the event of employment, any failure to disclose such convictions could result in dismissal. Information given is confidential and will only be considered for the purposes of the application. If there is any such information you wish to provide?


I agree that there is nothing which would prevent me from doing this job.


The organisation will hold your data on file for twelve months after the end of the relevant recruitment process if you provide consent. The purpose of retaining your data with your consent is to allow you to apply easily for other jobs we may have available. At the end of the twelve months period you will be required to complete a new application form in order to remain on our system. You may withdraw your consent for us to hold your data at any time after the initial recruitment process is completed. I consent for my personal data to be held and agree that Dewis CIL may keep this application form on file for twelve months. It may be used for future prospective employers. I understand that you will contact me in due course should any such person make themselves known to you.


What geographical area's are you able to cover?


How many hours of work can you offer per week?


Last Update

2019-08-22 02:00:13