254RCT Personal Assistant Application Form Submission Title *: Mrs.First Name *: Last Name *: Address 1 *: Address 2: trecynon Town *: Aberdare County *: mid Glamorgan Postcode *: Cf44 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. *: Currently a project manager for a learning disability charity Mencap. Part of my role is to actively support on the projects. I have experience working with young adults with a range of difficulties. Part of that role involved working with a group of 10 people to undertake a new leisure activities with the hope they would retain confidence to continue independently. Also I have supported a young lady through dewiscil previously.What qualities do you think are important when working as a personal assistant with a disabled person? *: I believe that the person has to be responsible and reliable in order for them to be trusted by the person. Good listening skills and listen to what the person is saying and allow them to speak not overpower them. Good positive energy that brings happiness to the life of the individual in order to have fun.How do you think you can contribute towards the needs and the independence of a disabled person? *: Have experience with sourcing new activities and supporting young people to overcome fears and join in.What is it about PA work which appeals to you? *: I enjoy 1:1 working and making a difference to the lives of people.What are your hobbies/interests?: Enjoy walking and recently start running.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? *: anyAre 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.: childcareIs 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. *: YesI 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?: Cynon areaHow many hours of work can you offer per week?: 20Please 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/Friday Overnight/Saturday AM/Saturday PM/Saturday Overnight/Sunday AM/Sunday PM /Sunday Overnight/Further Information: