Personal Assistant Application Form Submission 

Title *: . 
First Name *:  
Last Name *: 
Address 1 *: 
Address 2: 
Town *: Penygraig 
County *: Rhondda Cynon Taff 
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. *: I have been a personal assistant before through Dewis on a few occasions helping people with their day to day lives. It’s something I thoroughly enjoy and was currently doing up until September. 
What qualities do you think are important when working as a personal assistant with a disabled person? *: I think being reliable, trustworthy, respectable are all important when working as a personal assistant. I thoroughly enjoy helping others and making a difference to their lives. 
How do you think you can contribute towards the needs and the independence of a disabled person? *: As I have some years experience of this I think that will have a big part in what I can contribute to the independence of a disabled person, I have helped many different people with different disabilities in the past and recently. 
What is it about PA work which appeals to you? *: All my life I have wanted to help others live the most comfortable, normal happy lives as possible. I find it very rewarding knowing that I’ve made a difference to someone’s life. 
What are your hobbies/interests?:I enjoy being outdoors, I like going for walks, socialising, I like to cook and clean and spend time with my family. 
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 any days, I can also work nights if required. 
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.: 
Name *: 
In what capacity do you know this person (should not be a family member)? *: Has known me for a number of years, family friend. 
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?: Rhondda Cynon Taff, Mid Glamorgan 
How many hours of work can you offer per week?: 22.5 - 24 
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 /