Personal Assistant Application Form Submission

Title *: Miss.
First Name *:
Last Name *:  
Address 1 *:
Address 2:
Town *: Treorchy
County *: Rhondda Cynon Taf
Postcode *: CF42 
Phone number *:
Please enter your email address for submission confirmation. *:

Reference number of job being applied for *: 

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 am applying for my first job. I left school and I become a full time carer for a long time for a family member, who required round the clock care. He has since passed away. I am now available to start work immediately.

What qualities do you think are important when working as a personal assistant with a disabled person? *: To care.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I was caring for someone for so long that it just comes to me naturally. I am now looking for work only in the care sector.


What is it about PA work which appeals to you? *: I like the one to one care. With being a PA I would get to know the person I’m caring for.

What are your hobbies/interests?:

Would you consider a casual position if you are unsuccessful with this job? *: Yes
Do you drive? *: No
Are you a vehicle owner? *: No
Do you smoke? *: Yes
Are you able to undertake training? *: Yes
What days/nights are you able to work, or prefer to work? *: Monday-Friday. 9-4. Saturdays and Sunday. Anytime.
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.:

Rehabilitation of Offenders Act 1975 * Within the nature of the work for which you are applying this position is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1975 (Exemptions Order). Applicants are therefore not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of this Act. In the event of employment, any failure to disclose such convictions could result in dismissal. Information given is confidential and will only be considered for the purposes of the application.

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?: Pentre Ton Pentre Treorchy Cwmparc Ynyswen Treherbert
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/Saturday AM/Saturday PM/Sunday AM/

Further Information: