Personal Assistant Application Form Submission

Title *: Miss.

First Name *: 

Last Name *: 

Address 1 *:

Address 2: 


County *: RCT

Phone number:

Please enter your email address for submission confirmation.


Reference number of job being applied for:

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 previously worked as a Personal Assistant, my duties involved taking a young Lady to social events, to the gym and to Classes. I have also worked with three young Males, my duties involved taking them swimming, taking them food shopping, going to watch football matches and taking them for food. I have also worked as a support worker for both Males and Females that involved helping them with personal hygiene such as showring, shaving and getting dressed. I have worked with people who have learning Disabilities, Autism, Dementia, Challenging Behaviour, peg feeding and ADHD.

What qualities do you think are important when working as a personal assistant with a disabled person? *: A good sense of Humour, A good understanding of Confidentiality, A good understanding of respect and dignity. Never be judgemental, and be able to build a good trusting relationship with both the client and family.

How do you think you can contribute towards the needs and the independence of a disabled person? I’m very trustworthy and honest, with a good understanding of confidentiality. I enjoy meeting new people and building new friendships. Im flexible and have a good sense of humour. I have excellent listening and communication skills. Im very patient and polite and enjoy trying new hobbies.

What is it about PA work which appeals to you? *: I enjoy meeting new people and working with people.

What are your hobbies/interests?: I really enjoy the gym and walking. I like to watch Wales play football and Rugby and have gone to a few matches in Cardiff. I enjoy watching movies and board games.

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? *: Yes

What days/nights are you able to work, or prefer to work? *: I’m flexible

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.:

If there is any such information you wish to provide? *: 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 areas are you able to cover?: RCT
How many hours of work can you offer per week?: Flexible
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/Friday AM/Friday PM/Saturday AM/Saturday PM/Sunday AM/Sunday PM /
Further Information: