Personal Assistant Application Form Submission

Title *: Mrs.

First Name *: Lana

Last Name *: Warren

Address 1 *:

Address 2: Troedyrhiw

Town *: Merthyr Tydfil

County *: Merthryr Tydfil

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. *: My previous job was a personal assistant for an elderly lady 2004-2010

What qualities do you think are important when working as a personal assistant with a disabled person? *: Good personality, organizational skills, flexibility, problem-solving skills and patience

How do you think you can contribute towards the needs and the independence of a disabled person? *: With interest, patience, understanding and motivation
What is it about PA work which appeals to you? *: I get great satisfaction from supporting/helping people

What are your hobbies/interests?: Walking my 3 dogs, making garments using my sewing machine and arts and crafts.

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


Are you a vehicle owner? *: Yes

Do you smoke? *: Yes

Are you able to undertake training? *: Yes

What days/nights are you able to work, or prefer to work? *: I am avavailable day or night

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.:

Job Title

Address *:
Phone Number *:
In what capacity do you know this person (should not be a family member)? *:
Name *: Heather Wynne

Job Title *: r

Address *:

Phone Number
In what capacity do you know this person (should not be a family member)? *: Friend
If there is any such information you wish to provide? *: Yes

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 areas are you able to cover?: Merthyr Tydfil County Borough
How many hours of work can you offer per week?: 37.5

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