Personal Assistant Application Form Submission

Title *: Mrs.

First Name *: Traci

Last Name *: Williams

Address 1

Address 2: West end

Town *: Abercarn

County *: Caerphilly

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. *: I have worked with a range of people from autism to mental health, Ive worked secure, medium units to supported living.

What qualities do you think are important when working as a personal assistant with a disabled person? *: The people that employ me as a PA are no different to anyone else, apart from we are our own individuals.

How do you think you can contribute towards the needs and the independence of a disabled person? *: Helping them achieve a normal life as possible, helping them reach their goals.

What is it about PA work which appeals to you? *: The 1-1 connection you can get with a particular individual, also the different range of individuals.

What are your hobbies/interests?: Dogs Walking

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? *: Yes

Are you able to undertake training? *: Yes

What days/nights are you able to work, or prefer to work? *: Thursday afternoon/ Saturday

Are there any circumstances which would prevent you from providing cover or swapping a shift? *: No

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 *:

Job Title *:
Address *:
Phone Number *:

In what capacity do you know this person (should not be a family member)?
If there is any such information you wish to provide? *: Yes

Please provide details if necessary: NVQ 2 QCF3 Registration number: W/5021956

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?: 12 to start as Im working another job but looking to find PA full time work eventually.

Please indicate the approximate times that you are available for work throughout the week.: Thursday PM/Saturday AM/Saturday PM/
Further Information: