Personal Assistant Application Form Submission


Title *: .


First Name *: 


Last Name *:

Address 1 *: 


Address 2:
Town *: Barry


County *: South Glamorgan


Postcode *: 


Phone number *: 


Please enter your email address for submission confirmation. *:


Reference number of job being applied for *: Vog362
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 work with a man with a brain injury in Barry and have been with him for 8 years. We go for days out shopping any appointment ect also spent time in the house chatting ect I help out around the house washing ironing ect I also make sure he is safe while his wife is at work .
What qualities do you think are important when working as a personal assistant with a disabled person? *: Using the time effectively so that my client finds the time enjoyable also that he feels independent and also safe .
How do you think you can contribute towards the needs and the independence of a disabled person? *: To be non judgemental and always listen to them Take into account their wishes whilst also making sure they are safe .
What is it about PA work which appeals to you? *: I enjoy working one to one hopefully making someone life more worthwhile and enjoyable Keeping independence and dignity
What are your hobbies/interests?: I enjoy spending time with my children and also looking after people I have four dogs who I adore and love all animals I like reading music quiz shows I am learning tae chi and also take my client once a week I like walking love the beach.


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? *: Weekend days or evenings, all day Thursday or evenings


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 look after my client four daytimes a week


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)? *: House keeper


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?: Barry Rhoose Cardiff


How many hours of work can you offer per week?: 12


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