Personal Assistant Application Form Submission


Title *: Miss.
First Name *:
Last Name *:
Address 1 *:
Address 2: Llwydcoed
Town *: Aberdare
County *: Rhondda Cynon Taff
Postcode *: Cf44 
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 dont have any qualifications in this line of work but I am willing to learn and do the Very best for the job.
What qualities do you think are important when working as a personal assistant with a disabled person? *: Being caring, understanding, a good listener, empathetic. And respect them their home and privacy.
How do you think you can contribute towards the needs and the independence of a disabled person? *: I will try my best to help as best has I can and work to the Best Of my ability.
What is it about PA work which appeals to you? *: Helping. Caring. I dont mind all house work chores and I like to have a challenge.
What are your hobbies/interests?: Coin collecting, antiques. Keeping fit/ healthy.


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? *: No
Are you able to undertake training? *: Yes
What days/nights are you able to work, or prefer to work? *: Days Monday to Friday
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.: I have put down days Monday to Friday as I am single parent and my little one is in school then I don’t have anyone to help me to do evening shifts.


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?: Aberdare area
How many hours of work can you offer per week?: 20
Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Tuesday AM/Wednesday AM/Thursday AM/Friday AM/


Further Information: