Personal Assistant Application Form Submission 

Title *: . 
First Name *: 
Address 1 *: 
Address 2: Penarth 
Town *: Vale of glamorgan 
County *: Wales 
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. *: Very experienced caring for people living with dementia Worked as a nurse for many years Up to date with training. 
What qualities do you think are important when working as a personal assistant with a disabled person? *: Excellent verbal. And non-verbal skills Kind friendly person-centred approach. 
How do you think you can contribute towards the needs and the independence of a disabled person? *: Encouraged person to fulfil potential living with disability. 
What is it about PA work which appeals to you? *: Individual care and interaction. 
What are your hobbies/interests?:Secretary of a organisation Enjoy travel. 
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? *: Flexible 
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.: I am flexible no commitments 
Name *: 
In what capacity do you know this person (should not be a family member)? *: 
Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? *: 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).: No 
What geographical area’s are you able to cover?:Penarth Barry Cardiff 
How many hours of work can you offer per week?:Negotiable 
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/Saturday PM/Sunday AM/Sunday PM / 
Further Information: I have joined the CRB update service Have CRB dated 29th September 2020