Personal Assistant Application Form Submission


Title *: Miss.


First Name *:


Last Name *:


Address 1 *:


Address 2:


Town *: Pontyclun


County *: Wales


Postcode *:
Phone number *:


Please enter your email address for submission confirmation. *:
Reference number of job being applied for *: DPC1495


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 able to help to assist in any home needed help. If that be cleaning or organising as i have experience in domestic cleaning.


What qualities do you think are important when working as a personal assistant with a disabled person? *: I am a very patient and trustworthy person, always willing to give a helping hand. Im easy to get along with and very understanding.


How do you think you can contribute towards the needs and the independence of a disabled person? *: I can help with any house hold work, i can assist it any medication if needs to be taken and i want to be able to make someones life a little easier and make a difference in their lives.


What is it about PA work which appeals to you? *: The thought of being someones helping friend, someone that can help them with anything they may need.


What are your hobbies/interests?: Reading, music, movies, painting some cooking


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? *: Any time


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)? *: Name *: Job Title *: Address *:
Phone Number *:
In what capacity do you know this person (should not be a family member)? *: Friend


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?: Pontyclun, Llantrisant, talbot green, beddau, church villiage


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