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Personal Assistant Application Form Submission

Title *: Mr.
First Name *:
Last Name *:
Address 1 *:
Address 2: Llanrumney
Town *: Cardiff
County *: South Glam
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. *: Previous taxi driver 35 years plus Cared for mother with Dementia Wheelchair experience

What qualities do you think are important when working as a personal assistant with a disabled person? *: I believe you need to be caring, considerate, look out for their safety and keep them at ease while they are in your care. I am a kind loyal person and love seeing people enjoy their life the best possible way,

How do you think you can contribute towards the needs and the independence of a disabled person? *: With my previous experience with taxi driving, I experienced many disabilities and learned how to deal with these adequately. After looking after my elderly mother who sadly passed aged 92. She suffered dementia and I was a big part of her life and helped her through this condition to make her feel comfortable.

What is it about PA work which appeals to you? *: I love seeing people happy and enjoying their life the best way possible. I also think this application would work perfectly for me because I live in the same area.

What are your hobbies/interests?: Music, DIY, watching films, cleaning, cooking, walking my dogs, take my wife shopping, occasionally eating out, coastal holidays in my caravan.

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? *: Yes

Are you able to undertake training? *: Yes

What days/nights are you able to work, or prefer to work? *: Days, early evenings

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.:
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 convictions? *: 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?: Llanrumney and adjacent areas.

How many hours of work can you offer per week?: 20

Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Tuesday AM/Tuesday PM/Wednesday AM/Wednesday PM/Thursday AM/Thursday PM/Friday AM/Friday PM/Saturday PM/
Further Information: I have a good geographic knowledge of Cardiff and district areas due to being a taxi driver for many years. I also have experience of transporting disabled persons into vehicles. I am hard working, conscientious worker who takes pride in my work. I am a happy easy to get along with person and gel pretty quickly. I have 3 grown up children and 3 grandchildren. I look forward to hearing from you. Kind regards, Derek Davies