Personal Assistant Application Form Submission

Title *: Mrs.

First Name *: 

Last Name *: 

Address 1 *:

Address 2:

Town *: Barry

County *: Wales

Phone number *: 

Please enter your email address for submission confirmation. *:

Reference number of job being applied for *: Vog625

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’ve worked with a disabled man who has angle syndrome

What qualities do you think are important when working as a personal assistant with a disabled person? *: Someone who is kind willing to help and enjoy what they do

How do you think you can contribute towards the needs and the independence of a disabled person? *: I’m hard working willing to do what ever is needed

What is it about PA work which appeals to you? *: I loved working with the lad I was with and I like the one to one

What are your hobbies/interests?: Spending time with my kids

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? *: Any time

Are there any circumstances which would prevent you from providing cover or swapping a shift? *: No


If you would like to expand on the answers given above? Please use the box below.:
Name *:

Job Title *:

Address *:

Phone Number

In what capacity do you know this person (should not be a family member)?

Name *:

Job Title *:

Address *:
Phone Number
In what capacity do you know this person (should not be a family member)? *: Family friend

If there is any such information you wish to provide? *: Yes

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?: Vale of Glamorgan
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.