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Personal Assistant Application Form Submission

Title *: Mr.
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. *: My previous experience is a bit lacking. But I have been a chef for over 10 years, I have worked with people with learning difficulties e.g. severe dyspraxia/dyslexia and enabled them to work with me. Each week I help my friend in Grangetown, by walking their dog. She is an elderly lady and its a very strong dog!

What qualities do you think are important when working as a personal assistant with a disabled person? *: Caring towards the person, understanding their needs, calm, patient, treat them as an actual person.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I am a very caring person, by putting everyone before me. I can be patient when dealing with different people.

What is it about PA work which appeals to you? *: Flexibility around my life. Its very rewarding helping other people out.

What are your hobbies/interests?: walking, growing my own vegetables, taking my friends dog out for a walk. listening to a wide range of music

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? *: Monday to Friday, no weekends. Currently working 20hrs a week as a school cleaner, so would like either morning/day work

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 dont drive so depending on how far away the employer is, I would have to use public transport.

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?: Whitchurch, Birchgrove, Roath, Cathays, Cardiff City Centre, Gabalfa and Grangetown

How many hours of work can you offer per week?: 20 hours per week, Monday - Friday daytime

Please indicate the approximate times that you are available for work throughout the week.:
Further Information: