Personal Assistant Application Form Submission

Title *: 

First Name *: 

Last Name *:

Address 1 *: 13 Brook Street

Address 2:
Town *: Treforest


County *: Pontypridd

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. *: De Nobles Hotel Oyigbo, Rivers State Nigeria
What qualities do you think are important when working as a personal assistant with a disabled person? *: Caring Patience Listening Safety skills

How do you think you can contribute towards the needs and the independence of a disabled person? *: Giving my best

What is it about PA work which appeals to you? *: Taking care of the disabled itself
What are your hobbies/interests?:

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? *: Wednesdays
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.: Wednesdays Saturday Sunday

Name *: 

Job Title *: 

Address *: 

Phone Number *:

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

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 post

ed to the Dewis CIL PA noticeboard (all personal information will be withheld).: Yes
What geographical area’s are you able to cover?: Pontypridd

How many hours of work can you offer per week?: 20

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