Personal Assistant Application Form Submission

Title *: Miss.

First Name *: 

Last Name *: 

Address 1 *:

Address 2:

Town *: Llantrisant

County *: Mid Glamorgan

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

Reference number of job being applied for *: DP1530

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 work in a special school in Tonteg and I have a vast knowledge and experience of working with children and adults with learning disabilities.

What qualities do you think are important when working as a personal assistant with a disabled person? *: Sense of Humour, honesty and passion.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I will enable the client to be as independent as possible by supporting their needs.

What is it about PA work which appeals to you? *: Enabling a person to live their life.
What are your hobbies/interests?: Photography, going out, cinema, Ice Hockey.
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? *: Can only work after 4.00 pm Monday, Thursday, Friday - Can work all weekend if needed.

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)? *: Colleague

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?: Llantrisant, Pontyclun, Beddau, Church Village, Pontypridd

How many hours of work can you offer per week?: 10

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