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Personal Assistant Application Form Submission

Title *: Miss.
First Name *:
Last Name *:
Address 1 *:
Address 2:
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. *: I have cared for my mother. I provided her with personal care, helped with medication and taking her to all medical appointments. I had to cook for her provide with any other care needed.

What qualities do you think are important when working as a personal assistant with a disabled person? *: I am a very reliable person with good time keeping. I am a good listener and have excellent communication skills. I am good at following instructions and I can prioritise. I am a trustworthy and honest person, with a caring and friendly nature. I am a lively person with a bubbly personality.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I can help others by assisting with every day tasks and help make them feel more independent.

What is it about PA work which appeals to you? *: I want to help others live a normal life so they feel independent and I know that I have the skills to do this.

What are your hobbies/interests?: I like walking, skiing, cooking and going out to coffee shops. I also like outdoor activities and meeting new people.

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

Do you drive? *: No

Are you a vehicle owner? *: No

Do you smoke? *: No

Are you able to undertake training? *: Yes

What days/nights are you able to work, or prefer to work? *: I am free from 7am- 5pm, also I am free to do night work/ flexible.

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.:
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 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?: Ely, Fairwater, Canton, Llandaff, Penylan, Llanishen, Radyr, Pentwyn.

How many hours of work can you offer per week?: Up to 35 hours per week.

Please indicate the approximate times that you are available for work throughout the week.:
Further Information: I am a very reliable person.