Vacancy
Please provide the vacancy reference as shown on the job description/advert, e.g. "PUR-123-456":
Personal Details
Title:
e.g. Ms, Miss, Mrs, Mr, Mx, Dr, etc.
Gender:
Male
Female
Non-binary
Transgender
Intersex
Other
I prefer not to say
Address Line 2:
Address Line 3:
How far are you willing to travel? *
5 Miles
10 Miles
15 Miles
20 Miles
30 Miles
40 Miles
50 Miles
Your Availability
What is your hourly rate of pay expectation? *
£1.00
£2.00
£3.00
£4.00
£5.00
£6.00
£7.00
£8.00
£9.00
£10.00
£11.00
£12.00
£13.00
£14.00
£15.00
£16.00
£17.00
£18.00
£19.00
£20.00
£21.00
£22.00
£23.00
£24.00
£25.00
£26.00
£27.00
£28.00
£29.00
£30.00
When are you available to work?
Morning
Afternoon
Evening
Overnight
Monday
Monday, Morning
Monday, Afternoon
Monday, Evening
Monday, Overnight
Tuesday
Tuesday, Morning
Tuesday, Afternoon
Tuesday, Evening
Tuesday, Overnight
Wednesday
Wednesday, Morning
Wednesday, Afternoon
Wednesday, Evening
Wednesday, Overnight
Thursday
Thursday, Morning
Thursday, Afternoon
Thursday, Evening
Thursday, Overnight
Friday
Friday, Morning
Friday, Afternoon
Friday, Evening
Friday, Overnight
Saturday
Saturday, Morning
Saturday, Afternoon
Saturday, Evening
Saturday, Overnight
Sunday
Sunday, Morning
Sunday, Afternoon
Sunday, Evening
Sunday, Overnight
Which languages do you speak:
English
British Sign Language
Welsh
Polish
Romanian
Panjabi
Urdu
Portuguese
Spanish
Arabic
Other
Why do you want to be/What do you like about being a PA? *
This statement will be added to your PA profile which will be sent to Direct Employers if you are interested in a vacancy.
Please tell us about any hobbies or interests you have:
This information will be used where possible to match you with DP Holders who pursue (or would like to) common pastimes.
Employment Details
If you have a CV, please upload here:
Please provide details of your work history: *
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:
Employer:
Your job duties:
Please provide details of any lived experience you have of caring for someone:
If you selected 'Other', please specify here
Please advise if you can provide evidence such as certificates for the selected training:
Do you have any other qualifications or training certificates relevant to the role of Personal Assistant? Please list these here:
Do you have any access requirements or reasonable adjustments which you would like us to be aware of?
If you selected 'Other', please specify here
References
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
Please provide your 1st reference, which should be your most recent employer: *
Please provide your 2nd reference, which should be a previous employer: *
Please provide your Unique Taxpayer Reference (UTR):
Legal
Please confirm that you have no other business interests that could be a conflict of interest e.g. your own care company or care services.
Part of enrolment includes receiving regular emailed newsletters containing training updates, peer network group sessions and other relevant information. Please confirm you are happy to receive this email.
Please confirm that you wish to be kept informed of any other vacancies which may be suitable for you, by joining our Personal Assistant Register? Joining the Register will require the completion of a value-based screening, any mandatory training which has not yet been completed, as well as DBS and Reference checks - this allows you to commence a new role as quickly as possible as and when a suitable vacancy arises.
To ensure any delay in training doesn't act as a barrier to being 'matched' to a direct payment holder, please tick to confirm that you wish to move onto the PA Register once Screening, DBS and Reference checks have been completed, but commit to completing the mandatory training prior to being appointed to a role, and certainly no later than 3 months after being appointed.