204RCT Personal Assistant Application Form Submission Title *: Miss.First Name *: Last Name *: Address 1 *:Address 2: Gilfach goch Town *: Porth 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. *: 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. *: I have done independent living be for looking after husband and wife , in their home taking them out, I'm also a carer at the moment What qualities do you think are important when working as a personal assistant with a disabled person? *: Making sure their needs are met , How do you think you can contribute towards the needs and the independence of a disabled person? *: Taking them out doing stuff , and meeting their needs What is it about PA work which appeals to you? *: Just a bubbly person who loves helping other people with needs makes me feel happy , What are your hobbies/interests?: Love spending time with my kids and my fiance and family , I'm a outgoing person who loves meeting new people Would you consider a casual position if you are unsuccessful with this job? *: YesDo you drive? *: YesAre you a vehicle owner? *: YesDo you smoke? *: NoAre you able to undertake training? *: YesWhat days/nights are you able to work, or prefer to work? *: Days Are there any circumstances which would prevent you from providing cover or swapping a shift? *: YesIf you would like to expand on the answers given above? Please use the box below.: 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. *: NoI consent to the above *: 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?: Gilfach goch tonyrefail trebanog williamstown How many hours of work can you offer per week?: 10 to 15 hoursPlease indicate the approximate times that you are available for work throughout the week.: Monday AM/Wednesday AM/Thursday AM/Further Information: I work 24 hours a week but would love to help out in my spare time,