Personal Assistant Application Form Submission

Title *: 

First Name *: 

Last Name *: 

Address 1 *: 

Address 2:
Town *: Aberdare

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 recently come out of the Army my job was as follows:- Team Medic Combat Administrator. i have a wide knowledge of care as i have worked in a nursing home dealing with behaviour issues and mental illnesses. i have also worked with children as a Cadet instructor where i followed out a wide range of activities such as swimming, mountain climbing and rock climbing. im currently studing in University Of South Wales however, this is only on a friday and 09.00-11.30 on a wednesday. im studing Bachlors Degree in Policing.

What qualities do you think are important when working as a personal assistant with a disabled person? *: im a very kind natured person and always put others needs first. im reliable and trustworthy and respect others homes. im a very punctual person and will leave 1 months notice before any holidays a required. im a empathetic person and possionate towards my jobs. im able to communicate and listen well to others. i organise my own work load and able to plan any activites and care that need to be given.

How do you think you can contribute towards the needs and the independence of a disabled person? *: im a very positive person and im always looking how to adapt and over come different situations. i have qualifications in care adults aswell as children. i am able to give personal care and understand different behaviour issues.
What is it about PA work which appeals to you? *: i enjoy making a positive impact on others lifes. i enjoy meeting new people and getting to know people. i enjoy a rewarding job and walking into something different everyday.

What are your hobbies/interests?: i enjoy many activities such as:- mountain climbing/walking rock climbing swimming socialising

Would you consider a casual position if you are unsuccessful with this job? *: Yes

Do you drive? *: Yes

Are you a vehicle owner? *: Ye

Do you smoke? *: Yes

Are you able to undertake training? *: Yes

What days/nights are you able to work, or prefer to work? *: willing to work weekends and week days

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.:
Name *: 



Job Title *:

Address *: 


Phone Number *: 

In what capacity do you know this person (should not be a family member)? *: work related

Name *:

Job Title *:
Address *:
Phone Number *:
In what capacity do you know this person (should not be a family member)? *: N/A
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?: RCT Area
How many hours of work can you offer per week?: 16-20

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 PM/Wednesday Overnight/Thursday AM/Thursday PM/Thursday Overnight/Friday Overnight/Saturday AM/Saturday PM/Sunday AM/Sunday PM /
Further Information: i own my own vehicle. safe guarding certificate moving and handeling medication