Personal Assistant Application Form Submission


Title *: Mr.
First Name *:
Last Name *:
Address 1 *:
Address 2: Treherbert
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. *: My work history is as follows, August 1973-August 1995,worked as a precision engineer at Williams and Oakey engineering company, Radstock road, MIdsomer Norton, near Bath, England. From August 1995 until August 2000 worked at MAC marketing, Bowerhill industrial estate, Melksham,Wiltshire, as a machine operator.During these 5 years I was also a health and safety officer and a qualified 1st aider, and also worked part time as a cleaner during this employment. From September 2000 until November 2014 I was employed at Tyco fire protection products,(which later became Johnson Controls ltd). During this employment I was a safety behaviour coach, and a qualified 1st aider, responsible for approximately 15 individuals within the work environment. I also worked part time on Saturdays and Sundays at a care home as a care assistant for 6 months during this employment.
What qualities do you think are important when working as a personal assistant with a disabled person? *: A personal assistant must be patient, understanding, calm, friendly, committed to the work,and must have a genuine understanding of the needs of the person they are looking after, and be there to help not hinder, and let that person be as independent as they want to be.
How do you think you can contribute towards the needs and the independence of a disabled person? *: I am a very good listener and will be able to let a person tell me what they want me to do for them and with them, and be there for them as and when Im needed. I can be in the back ground to let the person have their independence, but their crutch to lean on when needed.
What is it about PA work which appeals to you? *: I would simply like to help people in their everyday life, to try and carry on as they used to, but with help as and when needed. I have been very fortunate in my life to have been fit and healthy so far and it would be amazing if I could use my knowledge, skills and fitness to help others.
What are your hobbies/interests?: I like sports, including karate and snooker. I like to keep fit and have previously run in the New York marathon.I am currently learning Spanish, and am interested in woodwork, vegetable gardening, religion and music.
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 to Friday and maybe a Saturday a couple of times a month.
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.:

In what capacity do you know this person (should not be a family member)? *: Production manager at my last employment.
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?: A range of up to 10 miles from Treorchy.
How many hours of work can you offer per week?: 20 approximately.
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/
Further Information: