Personal Assistant Application Form Submission 

Title (required): . 
First Name (required):  
Last Name (required):  
Address 1 (required): 
Town (required): Tonypandy 
County (required): Rhondda cynon taff 
Postcode (required): 
Phone number (required):  
Please enter your email address for submission confirmation. (required): 
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): I cared for both my parents while they were Ill, I also worked doe meals on wheels taking care of the elderly during my visits and making sure they have everything. Id there was ever a problem then I would always get in touch with management. 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Always be caring, compassionate and patient. I think its very important to always listen to the person in care and understand their needs throughout my visit. 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): I always think it is important to support both the person in need and the wife while they are in my care. 
What is it about PA work which appeals to you? (required): I like working with the elderly and always making sure they are okay at all times. 
What are your hobbies/interests?: I enjoy long walks, swimming and going shopping. 
Would you consider a casual position if you are unsuccessful with this job? (required): Yes 
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): Minimum 16 hour day work 
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): 
Phone Number (required): 
In what capacity do you know this person (should not be a family member)?  (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?: Rhondda 
How many hours of work can you offer per week?: Minimum of 16 
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/ 
Further Information: