Personal Assistant Application Form Submission

Title *: Mrs.
First Name *:
Last Name *:
Address 1 *:
Address 2: Ynysybwl
Town *: Pontypridd
County *: Rhondda Cynon Taff
Postcode *: CF37 
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. *: Resilient Development Worker Wellbeing tutor Previous carer to my mother who had a stroke and short term memory Currently a carer to my 90 year old dad who has dementia
What qualities do you think are important when working as a personal assistant with a disabled person? *: To be able to empathise Have a sunny and positive attitude Be totally reliable To know the importance of confidentiality and safeguarding Belief in equality
How do you think you can contribute towards the needs and the independence of a disabled person? *: I have a good understanding of education and the importance of having goals to help you achieve something I have a can do attitude but I am very practical I feel that dignity is very important and this must be always addressed
What is it about PA work which appeals to you? *: Helping other people to be able to live meaningful lives, seeing the difference good support can make to a persons well being.
What are your hobbies/interests?: I teach resilience and well being courses I crochet blankets for premature babies When I can I volunteer with 4paws and have two rescue animals
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? *: Days 3 days mon tues wed but flexible
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.: My dad has carers besides myself who come in mealtimes and in the morning, if he is ill or needs specific care he has to be my priority although I would do everything I could to not let anyone down

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?: Rct
How many hours of work can you offer per week?: 15 max
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/
Further Information: