Personal Assistant Application Form Submission 

Title *. 
First Name *:  
Last Name *:
Address 1 *:  
Address 2:  
Town *: Porth 
County *: Rct 
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 am a very friendly and reliable trustworthy person as a day job I work in the community as part of the district nurses team as a nurses assistant. I have quite a lot of experience with helping people with all different types of dementia. Before I joined the district nurses I also worked in a care setting where the majority of people I helped had dementia and thoroughly enjoyed it. 
What qualities do you think are important when working as a personal assistant with a disabled person? *: I think u must be friendly, patient, reliable, and trustworthy and very supportive and encouraging. Also always ensuring that the person you are supporting is safe at all times. 
How do you think you can contribute towards the needs and the independence of a disabled person? *: I like to think that I have gained quite a lot of experience over the years and would be happy to continue to help others where I can. I would always encourage the person to maintain their independence and always treat them with respect and dignity. 
What is it about PA work which appeals to you? *: I like helping people and love sharing what I have learned. I also like the thought of becoming someone’s friend that can genuinely help and support where I can. I think it is important for people to have as much support in their lives as possible. 
What are your hobbies/interests?: When I am not in work or not chasing my children around I like to read, I also like walk and enjoy adult colouring I find it very relaxing at times. 
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? *: No 
What days/nights are you able to work, or prefer to work? *: I would only be able to do a night over the weekend 
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.: 
Name *:  
In what capacity do you know this person (should not be a family member)? * 
In what capacity do you know this person (should not be a family member)? * 
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 
How many hours of work can you offer per week?: Night sits on weekends or evenings 
Please indicate the approximate times that you are available for work throughout the week.: Monday PM/Tuesday PM/Thursday PM/Friday PM/Friday Overnight/Saturday PM/Saturday Overnight/ 
Further Information: