PA Application Form

The first stage of your enrolment is to complete an application form. This provides us with information required to process your application. Please provide answers to the best of your knowledge and we can assist to fill in any gaps at a later stage if required.

Please note that not all of this information will be shared with the direct employer. We will create a 'profile' for you based on the information provided, which has the equivalent intention of a CV, to help the Direct Employer decide if you could be the right person for their vacancy.

Only when you are offered a position will full information be provided to the Direct Employer to process full pre-employment checks.

Please note you cannot save and come back later.


Are you completing this application in respect of a specific vacancy you have seen? *

Personal Details

e.g. Ms, Miss, Mrs, Mr, Mx, Dr, etc.
What is your driving status? *
Are you willing to drive for this role? *

Your Availability

Which client groups are you happy to work with? *
Are you looking for a permanent position or a temporary position? *
When are you available to work?
  Morning Afternoon Evening Overnight
What is your current employment status? (tick all that apply) *
Which languages do you speak:
Do you smoke? *
Are you willing to deliver personal care? *
Are you happy to work with individuals who have pets? *
What care and support needs can you work with? *
This statement will be added to your PA profile which will be sent to Direct Employers if you are interested in a vacancy.
This information will be used where possible to match you with DP Holders who pursue (or would like to) common pastimes.

Employment Details

This should include the last 10 years or when you started working if this was less than 10 years ago. Please include any PA employment as well. For each role, please include:
  Dates Worked: MM/YYYY - MM/YYYY
  Job Title:
  Your job duties:
What relevant training have you completed? *
Ethnicity: *
Asian or Asian British
Black, Black British, Caribbean or African
Mixed or multiple ethnic groups
Other ethnic group
Not Stated


Please provide reference details in the boxes below. We will not contact them. We obtain the details for the Direct Payment Holder. They will only be contacted if you accept a job vacancy in the future.

Please Include:

  • Job Title
  • Their Name
  • Their Position
  • Company
  • Email
  • Telephone
  • Dates Worked
Are you eligible to work in the UK? *
DBS Status: *
On what basis would you prefer to work as PA? * (you would need to possess or set up public liability insurance)
Are you currently a self-employed PA? *
Do you have public liability insurance? *