Personal Assistant Application Form Submission


Title *: Mr.
First Name *: 
Last Name *: 
Address 1 *:
Address 2: Windsor court
Town *: Barry
County *: Vale of Glamorgan
Postcode *: CF62 
Phone number *:
Please enter your email address for submission confirmation. *: 


Reference number of job being applied for *: 


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’m currently employed as a support worker and have three years’ experience. I’ve supported individuals with various complex needs.


What qualities do you think are important when working as a personal assistant with a disabled person? *: I’m a calm, friendly, understanding and energetic individual that enjoys supporting people in the community.


How do you think you can contribute towards the needs and the independence of a disabled person? *: I’ve previous experience in similar roles and worked at vision 21 where Id help support individuals with tasks within the project.


What is it about PA work which appeals to you? *: I get job satisfaction of knowing someone has had a good day and I’ve helped others with some respite. I also enjoy the characters and getting to know a person.


What are your hobbies/interests?: I’m a qualified football coach so do volunteer work with kids football. I have three children of my own so supporting them with their activities outside of school is one if my main hobbies along with football coaching.


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? *: Mon-Fri days
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.: I would be unable to work a Saturday due to volunteer commitments and my children stay over with me on a Saturday evening/night.


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?:
How many hours of work can you offer per week?: 50
Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday Overnight/Tuesday AM/Tuesday Overnight/Wednesday AM/Thursday AM/Thursday Overnight/Friday AM/Sunday PM /Sunday Overnight/


Further Information: