Personal Assistant Application Form Submission 

Title *:
First Name *: 
Last Name *: 
Address 1 *: 1
Address 2: TRECYNON 
Town *: Aberdare 
County *: Mid Glamorgan 
Postcode *: 
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. *: Although I dont have care experience, I do have a lot of life experience. I have excellent customer service and people skills. 
What qualities do you think are important when working as a personal assistant with a disabled person? *: I believe a positivity, outgoing and honesty are key skills when working with someone who has a disability, as well as being reliable. 
How do you think you can contribute towards the needs and the independence of a disabled person? *: I have excellent people skills, and a positive, can do attitude. I believe I could encourage and support an individual to do things they enjoy to give the best quality of life. 
What is it about PA work which appeals to you? *: I love working with people, and I like the idea of being able to help someone achieve things they would otherwise struggle to do without support. 
What are your hobbies/interests?:I love watching movies, reading, shopping, dining out, and exploring new places. 
Would you consider a casual position if you are unsuccessful with this job? *: No 
Do you drive? *: Yes 
Are you a vehicle owner? *: Yes 
Do you smoke? *: Yes 
Are you able to undertake training? *: Yes 
What days/nights are you able to work, or prefer to work? *: Monday-friday daytimes. 
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 would potentially struggle to cover a shift at short notice if I didnt have childcare, although childcare can easily be arranged with a little bit of notice. 
Name *:  
In what capacity do you know this person (should not be a family member)? *: 
Name *: 
In what capacity do you know this person (should not be a family member)? *: Work experience 
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?: RCT, MERTHYR, CARDIFF 
How many hours of work can you offer per week?: 25 
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/Saturday PM/Sunday AM/Sunday PM / 
Further Information: