Fillable Printable Application Form as a PERSONAL ASSISTANT

Application Form as a PERSONAL ASSISTANT

Surname Title

(Mr/Mrs/Ms/Miss/etc)

Forenames

Address

Contact

Current Employment Details

Relevant Qualifications/ Education

This box MUST be filled in

Please read the Job Description carefully before providing

information in this Section of the Application Form

Office Ref

Home

Mobile

Job Reference Number on front of

Job Description

Office Use Only Date acknowledged Date copied to client

PERSONAL ASSISTANT

Application Form

E-mail

Work

Give details of your previous employment or experience which you

think would help you to do this job

What qualities do you think are important when working as a personal

assistant with a disabled person?

How do you think you can contribute towards the needs and the

independence of a disabled person?

What is it about PA work which appeals to you?

Would you consider a casual position if you are unsuccessful with this

job?

Do you drive, and what transport arrangements can you make for

work and providing cover?

Do you smoke? Are you prepared to undertake training?

What days/nights are you able to work, or prefer to work?

Are there any circumstances which would prevent you from providing

cover or swapping a shift?

References

Please supply the name, address and telephone number of two people who

would be prepared to give you both verbal and written references. One of these

persons should be able to comment on you in terms of employment.

Within the nature of the work for which you are applying this position is exempt from the

provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the

Rehabilitation of Offenders Act 1975 (Exemptions Order). Applicants are therefore not entitled

to withhold information about convictions which for other purposes are ‘spent’ under the

provisions of this Act. In the event of employment, any failure to disclose such convictions

could result in dismissal. Information given is confidential and will only be considered for the

purposes of the application. If there is any such information you should supply it below.

I agree that Dewis CIL may keep this application form on file for six months. It may be used

for future prospective employers. I understand that you will contact me in due course should

any such person make themselves known to you.

I agree that there is nothing which would prevent me from doing this job.

If you are satisfied that the information is accurate and complete, please sign it and return it

promptly to this address or e-mail it back and it will be passed on to the person who is

recruiting a personal assistant:

Dewis Centre for Independent Living

Amber House

Upper Boat Business Park

Pontypridd CF37 5BP

Name

Address

Postcode

Tel.no./Mobile

E-mail

Reference 2

In what capacity do you know

this person (should not be a

family member)?

Reference 1

In what capacity do you know

this person (should not be a

family member)?

Name

Address

Postcode

Tel.no/Mobile

E-mail

Signed

Date