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Personal Assistant Application Form Submission


Title *: Mr.
First Name *:
Last Name *:
Address 1 *:
Address 2:
Town *: Abercwmboi
County *: Rhondda Cynon Taff
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 been working in care for 22 years for the past 8 years I have owned and run my own Domiciliary Care Agency where I employed 28 staff. I have gained my NVQ3 in health and social care and QCF 5 in Management, I am trained in) First aid, Administration of medication, Health and safety, Manual handling, Fire safety, Food hygiene, Safeguard of vulnerable people, Risk Assessments,
What qualities do you think are important when working as a personal assistant with a disabled person? *: Reliable, dedicated, passionate, remain calm under pressure, caring nature, able to adapt to changing circumstances,
How do you think you can contribute towards the needs and the independence of a disabled person? *: I would help to enable independence by assisting with tasks that can be achieved and find solutions to other tasks to make them easier to achieve with minimal or no assistance if safe to do so.
What is it about PA work which appeals to you? *: I have always done care work I love working one on one in the community.
What are your hobbies/interests?: Walking, reading, animals, art.
Would you consider a casual position if you are unsuccessful with this job? *: No
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 Any hours and weekends can be agreed upon
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? *: 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?: Abercwmboi and a 5 mile radius approximately
How many hours of work can you offer per week?: 30
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 would ideally like to work Monday to Friday however weekends can be mutually agreed upon.