Personal Assistant Application Form Submission

Title *: Mr.

First Name *: 

Last Name *: 

Address 1 *:

Address 2

Town *: Tonypandy

County *: Rhondda Cynon Taff

Postcode *:
Phone number *: 4

Please enter your email address for submission confirmation. *:

Reference number of job being applied for *: DP1080

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. *: Im currently a qualified mental health nursing working on a male rehabilitation unit in Treorchy. I specialise in helping individuals gain confidence, increasing their independence and improve their social skills. I am also able to help with your anxiety and be able to guide you to develop coping mechanisms which you can use for the rest of your life.

What qualities do you think are important when working as a personal assistant with a disabled person? *: You have to have patience, be honest, motivated to help change. Empathy. Be able to instill a positive attitude to increase hope.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I believe I have all the qualities mentioned above. Being a nurse, i believe i am a very caring, honest, hardworking

What is it about PA work which appeals to you? *: I work 3 days a week in my current full time job therefore I have the time to apply for this type of work. I am a caring individual and enjoy helping people. Also given my experiences with my full time job, I believe I have all the attributes to help you positively develop as a person.

What are your hobbies/interests?: I am a massive Football fan, a Cardiff City and Wales season ticket Holder. I love boxing and rugby. I also go to the gym as regularly as I can. Enjoy social events such as eating out and cinema.

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? *: Shifts would be dependant on my current full time shift pattern, however I only work 3 times per week.

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.: My full time job. Potentially any physical health issues with my son.

Name *:

Job Title *:
Address *:
Phone Number *:
In what capacity do you know this person (should not be a family member)? *:

Job Title *:

Address *:
Phone Number *:
In what capacity do you know this person (should not be a family member)? Ward
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?: RCT

How many hours of work can you offer per week?: 5

Please indicate the approximate times that you are available for work throughout the week.:
Further Information: