Personal Assistant Application Form Submission

Title *: Mrs.

First Name *:

Last Name *: 

Address 1 *: Address 2: tonteg

Town *: pontypridd

County *: rct

Postcode *:

Phone number *: 

Please enter your email address for submission confirmation. *:Reference number of job being applied for *: DP1272

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. *: I have some caring experience and have completed a Health & Social care e learning programme. I have also completed practical training which focused on patient mobility. I also hold qualifications in food safety and preparation. I hold a full clean driving license and have my own car.

What qualities do you think are important when working as a personal assistant with a disabled person? *: The qualities i think are important working with a disabled person are empathy, integrity and hard working.

How do you think you can contribute towards the needs and the independence of a disabled person? *: By taking the time to understand them and their needs and then offering help and support that is appropriate to their needs.

What is it about PA work which appeals to you? *: I am friendly and outgoing and I like to help support people.

What are your hobbies/interests?: I enjoy walking my fathers dog, cycling and going to the cinema.
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

Are there any circumstances which would prevent you from providing cover or swapping a shift? *: No

If you would like to expand on the answers given above? Please use the box below.:
Name *:

Job Title *:

Address *: 

Phone Number *: 

In what capacity do you know this person (should not be a family member)? *: She was my manager for 6 years.

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?: RCT

How many hours of work can you offer per week?: 35

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/
Further Information: