To request further information or to arrange an interview please Click here

Reference #






First Name


Last Name


Address 1






Post Code




Email Address

Job reference number


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 previous cleaning experience within a food outlet establishment and takes pride in completing tasks to a high standard of cleanliness. Excellent communication skills from working in customer facing roles which includes serving customers and handling cash.
Tenovus Cancer 4 days
cleaning floors, taking our rubbish
kitchen units/tables cleaning bathroom area
Salvation Army Hostel
serving members their food
cleaning kitchen area

What qualities do you think are important when working as a personal assistant with a disabled person?

Being friendly and approachable as well as having patience and understanding. I am a hardworking reliable person with a mature and responsible attitude and enthusiastic approach to all aspects of employment. I am keen to learn new skills and undertake any training necessary.

How do you think you can contribute towards the needs and the independence of a disabled person?

By being as much help as I can but at the same time take a step back plus help them with daily tasks. I am an excellent communicator, got a good eye for detail, a team player and can use my own initiative.

What is it about PA work which appeals to you?

Everyday would be something different and I want to help people and make their lives a little easier.

What are your hobbies/interests?

Meeting new people
cooking different types of food

Would you consider a casual position if you are unsuccessful with this job?


Do you drive?


Are you a vehicle owner?


Do you smoke?


Are you able to undertake training?


What days/nights are you able to work, or prefer to work?


Are there any circumstances which would prevent you from providing cover or swapping a shift?


Would you like to expand on the answers given above? Please use the box below.


In what capacity do you know this person (should not be a family member)?

Reference upon request

In what capacity do you know this person (should not be a family member)?

Reference upon request

Rehabilitation of Offenders Act 1975 * Within the nature of the work for which you are applying this position is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1975 (Exemptions Order). Applicants are therefore not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of this Act. In the event of employment, any failure to disclose such convictions could result in dismissal. Information given is confidential and will only be considered for the purposes of the application. If there is any such information you wish to provide?


Please provide details if necessary


I agree that there is nothing which would prevent me from doing this job.


The organisation will hold your data on file for twelve months after the end of the relevant recruitment process if you provide consent. The purpose of retaining your data with your consent is to allow you to apply easily for other jobs we may have available. At the end of the twelve months period you will be required to complete a new application form in order to remain on our system. You may withdraw your consent for us to hold your data at any time after the initial recruitment process is completed. I consent for my personal data to be held and agree that Dewis CIL may keep this application form on file for twelve months. It may be used for future prospective employers. I understand that you will contact me in due course should any such person make themselves known to you.


What geographical area's are you able to cover?


How many hours of work can you offer per week?


Last Update

2019-05-23 10:09:24