167RCT Personal Assistant Application Form Submission Title (required): Miss.First Name (required): Last Name (required): Address 1 (required): Address 2: FerndaleTown (required): RCTCounty (required): Mid glamPostcode (required): Cf43 Phone number (required): Please enter your email address for submission confirmation. (required): Reference number of job being applied for (required): 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. (required): YesPlease 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. (required): I have worked for Dewis for many years, looking after various people, I enjoy supporting people to live a full happy life.What qualities do you think are important when working as a personal assistant with a disabled person? (required): I am patient, caring and understanding, I have a calming effect on people, I’m a good listener and fun to be with.How do you think you can contribute towards the needs and the independence of a disabled person? (required): The people that I have supported were not able to go out without me, with my support I was able to take them to various places to fulfil their lives.What is it about PA work which appeals to you? (required): I like to support people, take them out places and enjoy meeting new people.What are your hobbies/interests?: I love children and animals, I enjoy meeting new people, I enjoy shopping, cleaning, keeping fit and helping others.Would you consider a casual position if you are unsuccessful with this job? (required): YesDo you drive? (required): YesAre you a vehicle owner? (required): YesDo you smoke? (required): NoAre you able to undertake training? (required): YesWhat days/nights are you able to work, or prefer to work? (required): School hoursAre there any circumstances which would prevent you from providing cover or swapping a shift? (required): NoIf you would like to expand on the answers given above? Please use the box below.: I am a fit healthy non smoker who lives local.Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? (required): No/Please provide details if necessary:I agree that there is nothing which would prevent me from doing this job. (required): YesI consent to the above (required): YesI agree that the information I provide will be posted to the Dewis CIL PA noticeboard (all personal information will be withheld).: YesWhat geographical area’s are you able to cover?: Local to Ferndale RctHow many hours of work can you offer per week?: 16Please 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/Further Information: I would rather weekday school hours but may be flexible for nights and weekend.