Personal Assistant Application Form Submission


Title .


First Name


Last Name *:
Address 1 *:

Address 2: Llanrumney


Town *: Cardiff


County *: Glamorgan/ Morgannwg


Postcode *: 


Phone number: 


Please enter your email address for submission confirmation. *:

Reference number of job being applied for *: CDP1617


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 done Medication Administration, as well as prompting service users to take their medication at specific times. I have done personal care and various light domestic duties. Also have experience with meal preparation and prompting my grandmother to take her medication


What qualities do you think are important when working as a personal assistant with a disabled person? *: patience politeness discretion organisation and time keeping accuracy and attention to detail written and verbal communication skills


How do you think you can contribute towards the needs and the independence of a disabled person? *: I have patience and I am very polite and I know that dignity, discretion and tact are vital


What is it about PA work which appeals to you? *: The main thing that appeals to me about PA work is knowing that me doing my job is allowing the person(s) I have cared to have a more independent life


What are your hobbies/interests?: I enjoy TV and Film and as such i feel comfortable being either in watching the television or out at the cinema Im also a football fan (Liverpool)
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? *: any


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)? *:
Job Title *: Scheme Manager


Address *:
Phone Number *:
In what capacity do you know this person (should not be a family member)? *: Friend
Is there is any such information you wish to disclose relating to any convictions? *:
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 Trowbridge St Mellons
How many hours of work can you offer per week?: 39


Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Monday Overnight/Tuesday AM/Tuesday PM/Tuesday Overnight/Wednesday AM/Wednesday PM/Wednesday Overnight/Thursday AM/Thursday PM/Thursday Overnight/Friday AM/Friday PM/Friday Overnight/Saturday AM/Saturday PM/Saturday Overnight/Sunday AM/Sunday PM /Sunday Overnight/
Further Information: