Personal Assistant Application Form Submission 

Title (required):
First Name (required): 
Last Name (required): 
Address 1 (required): 
Address 2: 
Town (required): Tonypandy 
County (required): Mid Glamorgan 
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’ve always worked in retail and customer service and I would like a career change I’m a busy person who always like to be on my feet. 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Lots of patients. Chatty. Loving and caring Driven Hardworking Reliable Trustworthy 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): I am a very chatty bubbly outgoing person who likes to put a smile on people faces. If I could help someone day just simply being me I’m ecstatic 
What is it about PA work which appeals to you? (required): I love to help others 
What are your hobbies/interests?: I have two children I spent all my time with them when they are not in education. Also like socialising with friends and family. 
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): Any 
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): 
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?: Any 
How many hours of work can you offer per week?: 20 
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: