Personal Assistant Application Form Submission


Title *: Mr.
First Name *: 
Last Name *:
Address 1 *:
Address 2:
Town *: Porth
County *: Rct
Postcode *: Cf39
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. *: I worked on a voluntary basis with a young man with learning disability and cerebral palsy for the last 3 years


What qualities do you think are important when working as a personal assistant with a disabled person? *: I thinks it’s really important to have patience and understanding when working with individuals who need support and it’s really important to be reliable and respectful and have good under pressure and strive to help maintain independence of the individual I am working with


How do you think you can contribute towards the needs and the independence of a disabled person? *: I think I can provide a supportive role model while ensuring the individual feels supported to make decisions and I am also a very organised person who also comes from a care back ground so would be able to provide any care needs that would be needed


What is it about PA work which appeals to you? *: I like the thought of supporting an individual to be able to go out and enjoy what the world has to offer and also to be able to provide them with help and support in any way they would need it


What are your hobbies/interests?: Football weight training cinema music of all eras eating out and I enjoy being out in the car I love driving


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? *: Any shift except Thursday am as I do the school run with my 4 year old grandson as my sun and daughter in law both work


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.: Except reason given above


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?: Rct
How many hours of work can you offer per week?: 20
Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Monday Overnight/Tuesday AM/Tuesday PM/Tuesday Overnight/Wednesday AM/Thursday PM/Thursday Overnight/Friday AM/Friday PM/Friday Overnight/Saturday AM/Saturday PM/Saturday Overnight/Sunday AM/Sunday PM /Sunday Overnight/
Further Information: