Personal Assistant Application Form Submission

Title *: Mrs.

First Name *: 

Last Name *: 

Address 1 *: 


Town *: Ferndale, Maerdy

County *: Mid Glamorgan

Phone number
Please enter your email address for submission confirmation. *:

Reference number of job being applied for *: 

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. *: Current employment mill view care home ystrad Previous employment ysguborwen nursing home Previous employment radis community care

What qualities do you think are important when working as a personal assistant with a disabled person? *: Caring Hardworking Reliable Trustworthy Organised Respectful Kind

How do you think you can contribute towards the needs and the independence of a disabled person? *: By encouraging the individual but supporting them along the way and making sure they feel confident to carry out a task independently

What is it about PA work which appeals to you? *: Having that one to one with individuals so they have some continuity and gave trust and a relationship with the individual and get to know them as a person

What are your hobbies/interests?: Bingo Shopping Driving Socialising

Would you consider a casual position if you are unsuccessful with this job? *: Yes

Do you drive? *: Yes

Are you a vehicle owner? *: Yes
Do you smoke? *: No

Are you able to undertake training? *: Yes

What days/nights are you able to work, or prefer to work? *: All apart from Friday nights

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.: I have 2 children

If there is any such information you wish to provide? *: No

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 area’s are you able to cover?: Rhondda

How many hours of work can you offer per week?: 40

Please indicate the approximate times that you are available for work throughout the week.: Monday PM/Monday Overnight/Tuesday PM/Tuesday Overnight/Wednesday PM/Wednesday Overnight/Thursday PM/Thursday Overnight/Friday PM/Saturday PM/Saturday Overnight/Sunday AM/Sunday PM /Sunday Overnight/
Further Information: