Personal Assistant Application Form Submission

Title *: .

First Name *: 

Last Name *: 

Address 1 *: 

Address 2: Ferndale

Town *: Rhondda

County *: Mid-Glam

Postcode *: 

Phone number *: Please enter your email address for submission confirmation. *: eReference 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 have previously worked for Dewis for a lovely blind lady who enjoyed shopping and a lovely 97 year old lady who sadly died earlier in the year.

What qualities do you think are important when working as a personal assistant with a disabled person? *: I am reliable, friendly and calm person, people often feel comfortable telling me their problems as I am a good listener, with a calming affect on people.

How do you think you can contribute towards the needs and the independence of a disabled person? *: The people who I have supported are often housebound and just need support, they are grateful for any help I provide, only needing my support to enable them to go to appointments and places they love to go.

What is it about PA work which appeals to you? *: I like helping people to be able to improved their life, I enjoy taking them out places locally, when I see them enjoying themselves it makes me happy to.

What are your hobbies/interests?: I enjoy meeting new people, going for walks, listening to music, I love all animals, driving, children, watching tv, cleaning and love working and doing courses.

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? *: I prefer to work during school hours (9-3) local to Ferndale area.

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.: I prefer to work for Dewis as it is the only care work that you choose who you work for and what hours to suit you.

Name *: 

Job Title *: 

Address *: 

Phone Number *:

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

Name *: 

Job Title *: 

Address *: 

Phone Number *: 

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

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?: As close to Ferndale as possible

How many hours of work can you offer per week?: part time hours

Please indicate the approximate times that you are available for work throughout the week.:

Further Information: Recent courses I have done:- P.O.V.A Protection of vulnerable adults First Aid Managing anxiety psychology Mental health & wellbeing Autism and Aspergers Stress Management Any questions please feel free to ask me