Personal Assistant Application Form Submission

Title *: Mrs.
First Name *:
Last Name *:
Address 1 *:
Address 2: Rhoose Point
Town *: Nr Barry
County *: South Glamorgan
Postcode *: Cf61 
Phone number *:
Please enter your email address for submission confirmation. *:

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. *: I have been on a lot of council run courses, eg. manual handing, pova 1 and 2, dementia, motor neurone, medication, ms, food and hygiene, etc

What qualities do you think are important when working as a personal assistant with a disabled person? *: Listening skills are imperative, taking instructions, assisting the client whenever required and not taking over, being discreet and confidential with that persons condition and lifestyle.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I am willing to attempt most things within reason, have considerable knowledge that I can draw on to enable an easier life for the service user and would encourage anyone to be the best that they can be.


What is it about PA work which appeals to you? *: What appeals is helping others to achieve their goals, it’s nice to have made a difference to someone’s life.
What are your hobbies/interests?: Love gardening, chatting to people, lunching with service users, going on hols, spending time cavorting with the grandchildren.
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? *: Yes
Are you able to undertake training? *: Yes
What days/nights are you able to work, or prefer to work? *: Tuesdays 9 to 12 noon. Thursdays 9 to 12 noon
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 can only do the above hrs as I already work rest of week for other service users.

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?: Vale of Glamorgan only
How many hours of work can you offer per week?: 6

Please indicate the approximate times that you are available for work throughout the week.: Tuesday AM/Thursday AM/
Further Information: