Personal Assistant Application Form Submission 

Title (required): 
First Name (required):
Address 1 (required): 
Address 2: Trefechan 
Town (required): Merthyr tydfil 
County (required): Mid Glamorgan 
Postcode (required): 
Phone number (required):
Please enter your email address for submission confirmation. (required): deb_ 
Reference number of job being applied for (required):  
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. (required): 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. (required): 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): I have health and social care level 2. I respect the persons privacy and well-being 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): I can contribute by being there to support and help the person to their a repect them 
What is it about PA work which appeals to you? (required): I enjoy working as a pa as you are giving that person 110% of your time and work together with a team 
What are your hobbies/interests?: Driving/ travel/walking and spending time with my family 
Would you consider a casual position if you are unsuccessful with this job? (required): No 
Do you drive? (required): Yes 
Are you a vehicle owner?  (required): Yes 
Do you smoke? (required): No 
Are you able to undertake training? (required): Yes 
What days/nights are you able to work, or prefer to work?  (required): I can do anyshifts 
Are there any circumstances which would prevent you from providing cover or swapping a shift? (required): No 
If you would like to expand on the answers given above? Please use the box below.: 
Name (required): 
In what capacity do you know this person (should not be a family member)?  (required):  
Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? (required): No/ 
Please provide details if necessary: 
I agree that there is nothing which would prevent me from doing this job. (required): Yes 
I consent to the above (required): 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?: 
How many hours of work can you offer per week?: 
Please indicate the approximate times that you are available for work throughout the week.: 
Further Information: