Personal Assistant Application Form Submission

Title *: Mrs.

First Name *: 

Last Name *: 

Address 1 *:

Address 2:

Town *: Caerphilly

County *: Glamorgan

Postcode *:


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

Reference number of job being applied for *: DP1481

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 was a personal assistant for 3 plus years , for a lady who sadly passed away at the beginning of november. So I am currently looking for another PA position.

What qualities do you think are important when working as a personal assistant with a disabled person? *: Patience, caring nature compassion and utter respect to the person themselfs.

How do you think you can contribute towards the needs and the independence of a disabled person? *: By fully understanding the persons disability, and persons needs.
What is it about PA work which appeals to you? *: Working on a one to one basis, and building a friendship and bond with the person to whom I would be assisting.
What are your hobbies/interests?: I am a very social person. So I enjoy going out meeting different people , and enjoy the company of others. I love to go walking and visiting different places. EG. Cinema, pubs and restaurants.
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? *: Due to family commitments i am available to work afternoons and evenings only. Also happy to work every other weekend.

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)? *:
Name *:
Job Title *:
Phone Number

In what capacity do you know this person (should not be a family member)? *: Beverly is a friend of mine for whom I met through care work in the past.

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?: Surrounding areas of caerphilly, RCT, and cardiff.

How many hours of work can you offer per week?: 16

Please indicate the approximate times that you are available for work throughout the week.: Monday PM/Tuesday PM/Thursday PM/Friday PM/Saturday PM/Sunday PM /
Further Information: I have many years experience of care work in many different sectors. I love and enjoy making people who need added help in their lives, to make their life as normal and happy as possible.