Personal Assistant Application Form Submission


Title (required): Miss.
First Name (required): 
Last Name (required):
Address 1 (required):
Address 2:
Town (required): Pontypridd
County (required):
Postcode (required):
Phone number (required):
Please enter your email address for submission confirmation. (required):
Reference number of job being applied for (required): PA
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’ve got my own cleaning business & help a lot of people in the Pontypridd area especially the elderly which is my favourite part, it starts off with cleaning but I love to do a bit more for them like make beds put washing out etc. & it’s made me realise I’d like to also do this part as a living too.
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Caring, compassionate, patient, outgoing & confident.
How do you think you can contribute towards the needs and the independence of a disabled person? (required): I’d love to help with any house work, shopping. Day trips, walks anything the person would enjoy.
What is it about PA work which appeals to you? (required): I love to help people and don’t like to see people on their own.
What are your hobbies/interests?: Shopping, cleaning, sorting, talking, walking, also history.
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): No
Are you able to undertake training? (required): Yes
What days/nights are you able to work, or prefer to work?  (required): Only thing I have to do is school drop off & pickups
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.:
Name (required): Helen barker
Job Title (required): Dr
Address (required):
Phone Number (required):
In what capacity do you know this person (should not be a family member)?  (required): I’ve cleaned for her for 4 years
Name (required): Marilyn Jenkins
Job Title (required): Retired teacher
Address (required):
Phone Number (required):
In what capacity do you know this person (should not be a family member)?  (required): I’ve cleaned for her for 4 years
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?: Pontypridd
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 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/