Personal Assistant Application Form Submission

Title *: Mrs.

First Name *: 

Last Name *: 

Address 1 *:

Address 2:

Town *: Treorchy

County *: Rct

Postcode *:
Phone number *:

Please enter your email address for submission confirmation. *:
Reference number of job being applied for *: Dp1608

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 previously worked for ty pentwyn nursing home and also ystrad fechan nursing home I have Previous care experience.

What qualities do you think are important when working as a personal assistant with a disabled person? *: Reliable flexible compassionate must take into consideration privacy and confidentiality also making sure you give the client the upmost dignity they require.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I am a compassionate person currently working as a funeral director so I am used to families / people who get upset and agitated quite easily and can quickly calm the situation down . Making sure the client has their dignity and integrity. I also live a few hundred yards from the gentleman. Which would be ideal if he needs support and also have my own transport.

What is it about PA work which appeals to you? *: I love working with families and the general public I’m easy to talk to and always put families first .

What are your hobbies/interests?: I love spending time with my two little girls also love my job as a funeral director .
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? *: Evenings / weekends

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 work one weekend in 7 on call as a funeral director.

Name *:


Job Title *: Address *:
Phone Number *:

In what capacity do you know this person (should not be a family member)? *: Landlord of 15 years


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?: Treorchy/ treherbet

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/Tuesday PM/Wednesday PM/Thursday PM/Friday PM/Saturday AM/Saturday PM/Sunday AM/Sunday PM /
Further Information: