Personal Assistant Application Form Submission

Title *: 

First Name *: 

Last Name *: 

Address 1 *: 

Address 2: 

Town *: Swansea

County *: Swansea
Postcode *: 

Phone number *: 0

Please enter your email address for submission confirmation. *: 

Reference number of job being applied for *: VOG009

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 have over 5 years of care experience and I care for my mum at the moment.

What qualities do you think are important when working as a personal assistant with a disabled person? *: I am a very friendly and caring person

How do you think you can contribute towards the needs and the independence of a disabled person? *: I am willing to help anyone, and I find it very rewarding to do so.
What is it about PA work which appeals to you? *: It’s a very rewarding job, I also love helping people and meeting new people

What are your hobbies/interests?: I am into my cars so horse riding and socialising with friends and family

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? *: Monday - Friday 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 do care for my mum so if so shirt would need swapping I would have to check

Name *: 

Job Title *: 

Address *: 

In what capacity do you know this person (should not be a family member)? *: Used to be my old supervisor

Name *: 

Job Title *:

Address *:

Phone Number *: 

In what capacity do you know this person (should not be a family member)? *: My old manager

Is there is any such information you wish to disclose relating to any convictions? *: No/
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?: Beddau, Pontypridd, Talbot green, Pontyclun etc

How many hours of work can you offer per week?: Full time
Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Tuesday AM/Thursday AM/Friday AM/
Further Information: I can do some afternoons but all depends on times