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Title *: Mrs.
First Name *:
Last Name *:
Address 1 *:
Address 2: Old St Mellons
Town *: Cardiff
County *: South Glamorgan
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 been working with a 30 year old Down syndrome lady and also caring for my type 1 diabetic son. I am a very caring person and I can assist with helping them whilst in the home and taking them out shopping and socialising in the community.
 
What qualities do you think are important when working as a personal assistant with a disabled person? *: Providing the best service and a friendly approach and making sure they are happy to be able to do things that would make a difference in their lives.
 
How do you think you can contribute towards the needs and the independence of a disabled person? *: Giving the time and being a car owner help improve their day to day lives.
 
What is it about PA work which appeals to you? *: I have a friendly personality and enjoy caring for people especially when its making a difference to their lives.
 
What are your hobbies/interests?: Going to gym, cinema, socialising and meeting new people.
 
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? *: No
 
What days/nights are you able to work, or prefer to work? *: daytime work only
 
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 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?: Cardiff
 
How many hours of work can you offer per week?: 8-21
 
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/