128VOG Personal Assistant Application Form Submission Title *: First Name *: Last Name *: Address 1 *: Address 2: St athan Town *: Cardiff County *: 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 am at present a cleaner but I do have a lot of experience with disabled people these are my sister in laws and some of my customers that I clean for. What qualities do you think are important when working as a personal assistant with a disabled person? *: Making sure they are happy comfortable and safe. And making sure they have everything that they need or need doing. How do you think you can contribute towards the needs and the independence of a disabled person? *: I can contribute to their needs by being there for them and making them who they want to be. I will not hold them back but also not to put them in any danger. What is it about PA work which appeals to you? *: I want to give something back, an opportunity to make someone elses life just that little more exciting. What are your hobbies/interests?: Swimming driving knitting crochet looking after my children and grandchildren. Going on outings with my husband and children. 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 to Friday with the odd Saturday 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 also go back and forth to hospital as I have an autoimmune disorders but this does not stop me from doing my daily things. Name *: In what capacity do you know this person (should not be a family member)? *:Name *: Job Title *: Address *: 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).: Yes What geographical area’s are you able to cover?: Vale of Glamorgan and Bridgend How many hours of work can you offer per week?: Up to 16 hours 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 PM/ Further Information: Some of this days will have to be arranged with the client as I am self employed ckeaner.