Job Application

Please fill in the application form for the post of Live In PA (Personal Assistant) and if it is suitable our recruitment manager, Glyn Rose, will contact you.

Questions in bold are mandatory in order to complete the form.

First Name
Last Name
Home Phone
Mobile Number
Email Address
National Insurance No
Eligibility to Work in the UK
What kind of driving licence do you hold?
What type of car does your licence qualify you to drive?
I confirm that I am over 21, required for the clients car insurance
When are you able to start working with us?
Interests and Hobbies
Do you smoke?
Will you work with a client who smokes?
Have you worked as a carer before?
Your Employment History
Current or Last Employer's Company Name
Contact Name
Phone Number
Your Job Title
Start Date
Job End Date
Reason for leaving
Reference Contact Name (Person we can contact for a work reference at your last place of work )
Work Reference Telephone No
Character Reference Contact (Person we can contact for a character reference)
In what capacity have they known you?
Character Reference - Address
Character Reference - email address
Character Reference - phone:
Working as a PA
There is manual handling involved in this job, are you aware of any issues that would prevent you from carrying out these duties? If yes, please describe below.
Please describe any issues you may have with manual handling, if answered Yes to above question.
As our clients have complex health and personal needs, the duties that you are required to perform including: Cooking and general cleaning; Washing and Ironing; Shopping; Getting the client up and putting to bed; Showering; Personal care (this includes toileting and bowel care). I agree that:
Information required for the CRB check: The position you are applying for is listed in Schedule 1, Part II of the Rehabilitation of Offenders Act (Exceptions) Order 1975, Active Assistance is entitled to ask Exempted Questions as defined by Section 113(5) of the Police Act 1997 about you. From October 2003, Spinal Homecare is required by the Domiciliary Care Agencies Regulations 2002 to acquire a criminal record certificate in relation to any person who is a care manager or domiciliary care worker. This means that if your application is successful we will obtain from the Criminal Records Bureau a criminal record certificate relating to you, before your appointment is confirmed. You are however encouraged to tell us about your criminal record before we obtain a criminal record certificate.
Have you ever been convicted of a criminal offence?
Please list all your addresses over the past 5 years. This is where you have actually been living not just your official addresse(s)
Where did you hear about us?
If other, please list: