Personal Assistant Application Form Submission 

 
Title (required): . 
First Name (required):
Last Name (required):  
Address 2: 
Town (required): Rhoose 
County (required): Vale of Glamorgan 
Postcode (required):  
Phone number (required):  
Please enter your email address for submission confirmation. (required):  
Reference number of job being applied for (required)
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. (required): 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. (required): I have worked for the NHS for the last 9 years in healthcare roles. I have mainly worked with children but I feel my skills and knowledge could easily be adapted to caring for an adult. 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Time, respect, dignity. It is important to treat the person as an individual and involve them with all decisions about their care. 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): I am naturally a caring person and feel I can bond with people easily. I am empathetic, a good listener and like to help people the best I can. 
What is it about PA work which appeals to you? (required): The flexible nature of the role, no two days being the same. It it also nice to know youre making a difference to someones quality of life 
What are your hobbies/interests?:I play in a brass band (on hold due to covid) and I like to bake. I have a small cake business. 
Would you consider a casual position if you are unsuccessful with this job? (required): Yes 
Do you drive? (required): Yes 
Are you a vehicle owner?  (required): Yes 
Do you smoke? (required): No 
Are you able to undertake training? (required): Yes 
What days/nights are you able to work, or prefer to work?  (required): all - would prefer daytime shifts 
Are there any circumstances which would prevent you from providing cover or swapping a shift? (required): No 
If you would like to expand on the answers given above? Please use the box below.:We are shortly relocating to South Wales. I currently live in West Yorkshire. I am moving in with my in laws (the address provided) after Christmas whilst our house sale completes in St Athan. 
Name (required): 
In what capacity do you know this person (should not be a family member)?  (required): 
In what capacity do you know this person (should not be a family member)?  (required): 
Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? (required): No/ 
Please provide details if necessary: I am on the dbs update service 
I agree that there is nothing which would prevent me from doing this job. (required): Yes 
I consent to the above (required): 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?: Vale of Glamorgan 
How many hours of work can you offer per week?: 30 
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/ 
Further Information: Happy to do occasional overnight but wouldnt want regular over night care work.