Personal Assistant Application Form Submission

Title *: 

First Name *: 

Last Name *: 


Address 1 *:  
Address 2: 

Town *:
County *: RCT

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 20 years experience in the catering management industry so am able to plan menus, shopping lists, budgeting and preparation of food. Food safety training is up to date. I am patient, friendly and amenable but firm when necessary. I am employed as a lunchtime supervisor in a local primary where I have also worked as a play assistant in the nursery and a one to one support for additional needs children.

What qualities do you think are important when working as a personal assistant with a disabled person? *: To ensure that the individual is safe at all times. To be respectful of individual needs and to be able to ensure a full and active lifestyle (as required) is available. To ensure the individual has independence.

How do you think you can contribute towards the needs and the independence of a disabled person? *: To have an interest in their likes. To Have a respect for the individual and have an empathy to their requirements. To assist in activities and tasks. Able to chat and offer company.

What is it about PA work which appeals to you? *: Being able to assist and be helpful to an individual. Offering companionship. Part time hours.
What are your hobbies/interests?: Cinema, baking, knitting, sociable, theatre, travel, family time.

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? *: Mon, tues, wed, fri 9.15 to 12 noon, mon, tues, wed 2.30 to 4.30



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 have a part time job 12.30 to 2pm on Mondays to Friday.
Name *: 

Address *:Phone Number *: 


In what capacity do you know this person (should not be a family member)? *: Name *: Mrs Bryony Roberts



Job Title *:
Address *: Y 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?: Talbot Green and surrounding areas e.g Pontyclun, Llanharry, Llanharran, Cowbridge, Church Village, Llantrisant, Beddau etc
How many hours of work can you offer per week?: 10
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/Friday AM/
Further Information: I have a part time job between 12.30 and 2pm mon to fri.