Personal Assistant Application Form Submission 

Title (required): 
First Name (required):  
Address 2: 
Town (required):  
County (required): Vale of Glamorgan 
Postcode (required):
Phone number (required) 
Please enter your email address for submission confirmation. (required): 
Reference number of job being applied for (required):
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. (required): 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. (required): I worked for an agency in domiciliary care for 3 years and have been a personal assistant for just over a year. I’ve had experience with people who have Alzheimer’s and dementia. I provide relief to a spouse of someone who has dementia (been working there for a year) 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Be respectful, treat everyone as you would like to be treated, promote independence, a good sense of humour to name a few. 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): I always ask how the person would like things done as everyone is different and this allows the person to make their own decisions. Encouraging people to get out and about and feeling part of the community. If leaving the home is not an option then finding out what their likes and dislikes are for example listening to music and what type of music 
What is it about PA work which appeals to you? (required): I love what I do and feel I’m giving back to the community 
What are your hobbies/interests?: I enjoy travelling and meeting new people 
Would you consider a casual position if you are unsuccessful with this job? (required): Yes 
Do you drive? (required): Yes 
Are you a vehicle owner?  (required): Yes 
Do you smoke? (required): Yes 
Are you able to undertake training? (required): Yes 
What days/nights are you able to work, or prefer to work?  (required): Monday, Wednesday and Thursday afternoons. Tuesday and Friday mornings 
Are there any circumstances which would prevent you from providing cover or swapping a shift? (required): No 
If you would like to expand on the answers given above? Please use the box below.:I am a smoker but do not smoke when I’m at work 
Name (required): 
In what capacity do you know this person (should not be a family member)?  (required): 
In what capacity do you know this person (should not be a family member)?  (required): Ex colleague and friend 
Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? (required): No/ 
Please provide details if necessary: 
I agree that there is nothing which would prevent me from doing this job. (required): Yes 
I consent to the above (required): 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?: Barry 
How many hours of work can you offer per week?: 15 
Please indicate the approximate times that you are available for work throughout the week.: Monday PM/Tuesday AM/Wednesday PM/Thursday PM/Friday AM/ 
Further Information: