Personal Assistant Application Form Submission

Title *: Miss.

First Name *: Helen

Last Name *: Young

Address 1 *:
Address 2: Aberfan

Town *: Merthyr Tydfil

County *: Mid Glamorgan

Phone number *:
Please enter your email address for submission confirmation. *: m

Reference number of job being applied for *: DPM1566

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 been working as a Carer for an Agency for last 3.5 yrs. Before i looked after my brother who had a stroke for 15 yrs

What qualities do you think are important when working as a personal assistant with a disabled person? *: Being able to assist a person in their own home and offer my full support and care. Being able to create a bond with this person and trust is important. Making a person feel comfortable and as independendant as can be.

How do you think you can contribute towards the needs and the independence of a disabled person? *: Helping them achieve their maximum independence by assisting with all duties.

What is it about PA work which appeals to you? *: Being able to create a special work relationship and help to my full ability.

What are your hobbies/interests?: Watching tv Driving Going out for meals Gymnastics
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? *: Prefer most nights apart from weds

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)? *: at

Name *:

Job Title *:
Phone Number *:
In what capacity do you know this person (should not be a family member)? *: As a very dear friend

If there is any such information you wish to provide? *: 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?: Mèrthyr Tydfil

How many hours of work can you offer per week?: 40
Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday Overnight/Tuesday AM/Tuesday Overnight/Wednesday Overnight/Thursday AM/Thursday PM/Thursday Overnight/Friday PM/Friday Overnight/Saturday AM/Saturday Overnight/Sunday AM/Sunday PM /Sunday Overnight/
Further Information: