Personal Assistant Application Form Submission


Title *: 


First Name *: 


Last Name *: 


Address 1 *:


Address 2: 


Town *: Mountain ash


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 worked in the care sector for many of years so i know how challenging it can be


What qualities do you think are important when working as a personal assistant with a disabled person? *: All qualities are important to me wen caring for individuals


How do you think you can contribute towards the needs and the independence of a disabled person? *: Make sure that the person has is indepence I’m there to care for is needs
What is it about PA work which appeals to you? *: Iv always wanted to work as PA so

maybe now this is a good opportunity


What are your hobbies/interests?: Love watching both my sons playing rugby spending time with my family and walking my dog


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 days are suitable for me


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)? *: 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 posted to the Dewis CIL PA noticeboard (all personal information will be withheld).: Yes


What geographical area’s are you able to cover?: Mountain ash / Aberdare


How many hours of work can you offer per week?: 30
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: