Personal Assistant Application Form Submission

Title *:

First Name *: 

Last Name *: 

Address 1 *:
Town *:County *:Treorchy

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. *: i already work for dewis with 2 people. And have done this job caring for 12years mencap first then cartrefi cymru and innovate trust my imployer know but am looking to reduce my hours with them

What qualities do you think are important when working as a personal assistant with a disabled person? *: caring , honest ,happy and treating them like i would want to be treated myself

How do you think you can contribute towards the needs and the independence of a disabled person? *: being relyable hands on and very supported
What is it about PA work which appeals to you? *: making sure they have a good time and are happy either out and about doing activety or at home doing hobbies
What are your hobbies/interests?: gym , swimming , bowling , going to the cinama , driving to the sea side , holiday ,shows

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? *: i am very flexable
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 *: steve trehane

Job Title *:r

Address *: 

In what capacity do you know this person

rson (should not be a family member)? *:

Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? *: 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?: all r.c.t and futher with more hrs
How many hours of work can you offer per week?: 3hrs upto 20hrs
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/Friday Overnight/Saturday AM/Sunday Overnight/
Further Information: