Personal Assistant Application Form Submission

Title *: Miss.

First Name *: 

Last Name *: 

Address 1 *:

Address 2:

Town *: cwmparc


County *: RCT

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

Reference number of job being applied for *: DP825

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. *: Im currently in university studying to be a Chiropractor and through my studies I have learnt how visually impaired can affect a persons balance and co- ordination. In addition to the understanding of co-ordination problems I have a family member who has dyspraxia who I support on the weekends. I feel that my previous experiences and knowledge, would be beneficial to me if I was successful with this job and would help me encourage this lady to regain some independence in the activities she wishes.

What qualities do you think are important when working as a personal assistant with a disabled person? *: I think it is important to be caring, bubbly, compassionate, patient, friendly, encouraging and flexible.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I feel that being a caring, bubbly and encouraging person who can contribute to help people improve their independence while also meeting their needs that prevent them doing these.

What is it about PA work which appeals to you? *: I am a caring person who thrives off helping others and enjoying making a difference to peoples lives, but after starting my course, it has made me want to make an even bigger difference in promoting other peoples independence and making them feel more in control of their lives. Increasing peoples life satisfaction, by enabling them to do the things they love really appeals to me.
What are your hobbies/interests?: I enjoy keeping fit, by going to the gym and swimming. I also love shopping and eating out.

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


What days/nights are you able to work, or prefer to work? *: I am free during the days and nights Monday, Wednesday, Thursday. (Friday- during the day only).

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.: If I have an exam in University.

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

Job Title *:

Address *:

Phone Number *:
In what capacity do you know this person (should not be a family member)? *: Lecturer and personal tutor in university.

If there is any such information you wish to provide? *: Yes
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?: 12 hours.

Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Tuesday PM/Wednesday AM/Wednesday PM/Thursday AM/Thursday PM/Friday AM/
Further Information: