Personal Assistant Application Form Submission

Title *: Mrs.

First Name *: Elinor

Last Name *: Gilchrist

Address 1 *:
Address 2: n

Town *: Gilfach Goch

County *: RCT

Postcode *:
Phone number
Please enter your email address for submission confirmation. *:

Reference number of job being applied for *: DP1570

I confirm that I have the right to work in the UK and am able to prove my eligibility status when required to do so. *: Yes

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. *: QCF Level 5 in Health and Social Care QCF Level 3 in Health and Social care NVQ Level 2 in Health and Social Care

What qualities do you think are important when working as a personal assistant with a disabled person? *: Sensitive, thoughtful, compassionate, a people person, happy, ability to listen, caring, good communication skills, positive attitude

How do you think you can contribute towards the needs and the independence of a disabled person? *: I provide person centred support, meaning the individual is at the centre of everything I do for them, I help people maintain their independence by allowing and encouraging the individual to do as much for them selves as they possibly can.

What is it about PA work which appeals to you? *: This line of work appeals to me as it maintains continuity allowing the individual and my self to build a good working relationship

What are your hobbies/interests?: My interests are going out for meals and trying different cuisines

Would you consider a casual position if you are unsuccessful with this job? *: Yes
Do you drive? *: Yes

Are you a vehicle owner? *: Yes

Do you smoke? *: No

Are you able to undertake training? *: Yes

What days/nights are you able to work, or prefer to work? *: Monday to Friday and occasional weekends due to my son

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

If you would like to expand on the answers given above? Please use the box below.: Some times my husband works away only leaving me to care for my son although my son is in school Monday to Friday from 8 am to 4pm
Name *:

Job Title *:

Address *:


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

Name *:
Job Title *:
Address *:
Phone Number *:
In what capacity do you know this person (should not be a family member)? *:

If there is any such information you wish to provide? *: No

Please provide details if necessary:

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


I consent to the above *: Yes

I agree that the information I provide will be posted to the Dewis CIL PA noticeboard (all personal information will be withheld).: Yes

What geographical area’s are you able to cover?: Rhondda Cynon Taff and Bridgend
How many hours of work can you offer per week?: Full time
Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Tuesday AM/Tuesday PM/Wednesday AM/Wednesday PM/Thursday AM/Thursday PM/Friday AM/Friday PM/Saturday AM/Sunday AM/
Further Information: