Personal Assistant Application Form Submission

Title *: 

First Name *:

Last Name *: 

Address 1 *: 

Address 2: 

Town *: Llantwit Major

County *: Vale of Glamorgan

Postcode *: 

Phone number *: 

Please enter your email address for submission confirmation. *: 

Reference number of job being applied for *: VOG362 / VOG106 & what comes by that is suitable

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. *: Have had manual handling training whilst working in a care home. Carer and domestic work prior cleaned wards in UHW and worked shifts as a carer. All tasks including washing, dressing, mobilise, food preparation.

What qualities do you think are important when working as a personal assistant with a disabled person? *: Patience, caring skills, reliable, optimism, humour. Transport. Flexiblity. Fit, hands on attitude. Trustworthiness, supporting independence, respect, understanding.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I can help with domestic and care tasks. Ive worked as cleaner and carer in residential homes. I am always n time and can take the person in my care, can cook.
What is it about PA work which appeals to you? *: Working in a more private personal manner at someones home and have time for the person, so you can connect better, no rush (but crack on) :)

What are your hobbies/interests?: walking, swimming, theater, concerts, dancing, gardening, museum, history, travelling, social outings, coffee mornings
Would you consider a casual position if you are unsuccessful with this job? *: No

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 days, rather not weekends or nights. Max 4 days, part time. Usually keep a Tuesday morning free, but not a must.

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.: consider a casual position is negotiable

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)? *:
Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? *: 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?: Surrounding areas of Llantwit Major, rather not far out, preferably not Barry or Bridgend. I do not know my way around as I moved to the Vale a year ago.

How many hours of work can you offer per week?: Negotiable approx up till 4 days max
Please indicate the approximate times that you are available for work throughout the week.:

Further Information: Struggle with (heavy) hoisting (on my own) can work with asara. But quess work without hoisting more suitable for me right now.