Personal Assistant Application Form Submission

Title *: .

First Name *: 

Last Name *: 

Address 1 *: 1
Address 2:

Town *: Cwmparc

County *: RCT

Postcode *: 

Phone number *: 

Please enter your email address for submission confirmation. *: Reference number of job being applied for *: DP1538

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 currently in my third year of university, studying to be a chiropractor. In this course I have learnt about many developmental disorders - autism being one of them. So I am aware of what it is and how it affects people. I also know that there are different levels of autism. In addition to this, I am used to doing activities with a child with autism as my friends child has autism. This has helped me understand the disorder, and even though each person expresses different characteristics of autism, I feel this is still valuable experience to fulfil the needs of the young lady.

What qualities do you think are important when working as a personal assistant with a disabled person? *: I think its important to be caring, bubbly, compassionate, patient, friendly, encouraging and flexible.

How do you think you can contribute towards the needs and the independence of a disabled person? *: Being the caring, friendly and encouraging person that I am, I believe that I would be the stepping stone to help people socialise, be active and improve their independence.

What is it about PA work which appeals to you? *: I have always been a compassionate person that enjoys improving the lives of others, hence why im studying to be a chiropractor. Since beginning the course I have become more in love with the idea of helping people gain independence and improve their social skills by enabling them to do they things they love to increase their life satisfaction.

What are your hobbies/interests?: I am a very active and social person. I like to go to the gym and activity classes. I also love being outdoors, going for scenic walks and doing fun activities such as trampolining, bowling and playing arcade games.

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? *: monday wednesday thursday and friday day. monday tueday wednesday thursday sunday night

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 university on Tuesday day.

Name *:

Job Title *: 

Address *: T

Phone Number *: 


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

Job Title *:

Address *: 


Phone Number *: 07540993574
In what capacity do you know this person (should not be a family member)? *:
Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? *: 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?: whole of RCT


How many hours of work can you offer per week?: up to 16hrs

Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Tuesday PM/Wednesday AM/Wednesday PM/Wednesday Overnight/Thursday AM/Thursday PM/Thursday Overnight/Friday AM/Friday PM/Saturday AM/
Further Information: