36RCT Personal Assistant Application Form Submission Title *: Mrs. First Name *: Lana Last Name *: Warren Address 1 *: Address 2: Troedyrhiw Town *: Merthyr Tydfil County *: Merthryr Tydfil 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. *: My previous job was a personal assistant for an elderly lady 2004-2010 What qualities do you think are important when working as a personal assistant with a disabled person? *: Good personality, organizational skills, flexibility, problem-solving skills and patience How do you think you can contribute towards the needs and the independence of a disabled person? *: With interest, patience, understanding and motivationWhat is it about PA work which appeals to you? *: I get great satisfaction from supporting/helping people What are your hobbies/interests?: Walking my 3 dogs, making garments using my sewing machine and arts and crafts. Would you consider a casual position if you are unsuccessful with this job? *: YesDo you drive? *: Yes Are you a vehicle owner? *: Yes Do you smoke? *: Yes Are you able to undertake training? *: Yes What days/nights are you able to work, or prefer to work? *: I am avavailable day or night Are there any circumstances which would prevent you from providing cover or swapping a shift? *: Yes 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 *: Heather Wynne Job Title *: r Address *: Phone Number In what capacity do you know this person (should not be a family member)? *: FriendIf there is any such information you wish to provide? *: Yes 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 areas are you able to cover?: Merthyr Tydfil County BoroughHow many hours of work can you offer per week?: 37.5 Please indicate the approximate times that you are available for work throughout the week. Monday AM/Monday PM/Tuesday AM/Tuesday PM/Wednesday AM/Wednesday PM/Thursday AM/Thursday PM/Friday AM/Friday PM/Saturday AM/Sunday AM/Further Information: