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Personal Assistant Application Form Submission

Title *: Mrs.
First Name *:
Last Name *:
Address 1 *:
Address 2: Thornhill
Town *: Cardiff
County *: Cardiff
Postcode *:
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. *: Have 15 years experience working as a carer/personal assistant.

What qualities do you think are important when working as a personal assistant with a disabled person? *: Patience, flexibility of communication and ability to cater for individual needs.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I am patient methodical worker, very friendly and love helping people.

What is it about PA work which appeals to you? *: I enjoy making a difference to people’s lives.

What are your hobbies/interests?: Horse riding, gardening and shopping.

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

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 be flexible

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)? :

If there is any such information you wish to provide? *: 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?: Cardiff

How many hours of work can you offer per week?: 25 hours

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