Personal Assistant Application Form Submission

Title *: Miss.

First Name *: 

Last Name *:

Address 1 *:
Address 2:


County *: RCT


Phone number

Please enter your email address for submission confirmation. *:

Reference number of job being applied for *: Vog609

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. *: Nearly 10 years working primarily in domiciliary care. QCF 5 qualification completed. Specialist in living well with dementia.
What qualities do you think are important when working as a personal assistant with a disabled person? *: Patience, empathy and honesty
How do you think you can contribute towards the needs and the independence of a disabled person? *: By supporting that person to achieve more independence. By strengthening their confidence and self esteem
What is it about PA work which appeals to you? *: Its the most rewarding job Ive ever done.
What are your hobbies/interests?: Music, reading and i play the piano.
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? *: No
Are you able to undertake training? *: Yes
What days/nights are you able to work, or prefer to work? *: Any
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)? *: Colleague
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?: Vale of Glamorgan Cardiff
How many hours of work can you offer per week?: 20
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: