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Personal Assistant Application Form Submission


Title *: Miss.
First Name *:
Last Name *:
Address 1 *:
Address 2:
Town *: Treherbert
County *: Rct
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’m currently working for a company called Hafod as a community care worker
What qualities do you think are important when working as a personal assistant with a disabled person? *: Communication is key when working with other people. It also helps to have a bubbly personality as well.
How do you think you can contribute towards the needs and the independence of a disabled person? *: I can contribute my experience to the individual
What is it about PA work which appeals to you? *: Working and gaining a bond with an individual.
What are your hobbies/interests?: I really enjoy, reading, cooking and shopping
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? *: Monday morning, Tuesday evening, Wednesday all day Thursday afternoon and evening, Friday all day and all weekend
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 *:
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? *: 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?:
How many hours of work can you offer per week?: 40-50
Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday Overnight/Tuesday PM/Tuesday Overnight/Wednesday AM/Wednesday PM/Wednesday Overnight/Thursday PM/Thursday Overnight/Friday AM/Friday PM/Friday Overnight/Saturday AM/Saturday PM/Saturday Overnight/Sunday AM/Sunday PM /Sunday Overnight/
Further Information: