Personal Assistant Application Form Submission

Title *: r.

First Name *: 


Last Name *:
Address 1 *: 

Address 2: Town *: Cowbridge

County *: The Vale of Glamorgan

Postcode *:

Phone number *: 0Please enter your email address for submission confirmation. *: [email protected]

Reference number of job being applied for *: 

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. *: UWTSD, Swansea- BA in Public Services. Awarded third class honours. I have done domiciliary care before for Allied healthcare. Looking after vulverable adults with low mobility or dementia was a joy and what to do it again.

What qualities do you think are important when working as a personal assistant with a disabled person? *: Always being enthusiastic towards the person in care is integral. Patience and being aware of their needs is also very important. Being able to communicate, understand and to deliver the person in care values shows great quality of a care assistant.
How do you think you can contribute towards the needs and the independence of a disabled person? *: I can provide great help for a disabled person, making them independent by talking to them. Making them feel comfortable in my care. I will get information from Dewi/family members to know the persons like/dislikes, hobbies and interests. I can make them independent by letting them do the work and only step in when they need it.
What is it about PA work which appeals to you? *: Being a PA is a wonderful job. Your not just helping the person in care but also making a positive contribution for their family aswell. Looking after people provides great life experience which other jobs dont provide. Everyday is different.
What are your hobbies/interests?:

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? *: Available all week. Just need to have some Saturdays and Tuesdays off

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.:
Name *: Mohammed


Job Title *:
Address *: 5


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)? *: 

Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? *: 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, Barry
How many hours of work can you offer per week?: 50 hpw

Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Monday Overnight/Tuesday AM/Wednesday AM/Wednesday PM/Wednesday Overnight/Thursday AM/Thursday PM/Thursday Overnight/Friday AM/Friday PM/Friday Overnight/Saturday AM/Saturday PM/Saturday Overnight/Sunday AM/Sunday PM /Sunday Overnight/
Further Information: