Reference #

3488520 / 25RCT

Status

Complete

Title

Mrs.

First Name

Last Name

Address 1

Town

Mountain ash

County

Rct

Post Code

Cf45 

Phone

Email Address

Job reference number

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 am a registered paediatric nurse, I have worked on a paediatric ward for 5 years I have recently changed role within paediatrics and I am currently working in a special needs school as a nurse.

What qualities do you think are important when working as a personal assistant with a disabled person?

I am a very friendly person and easy to get on with, I have a great interest in a wide range of activities indoor and outdoors. I am confident within my role however if I am unsure of anything I am not afraid to ask for advice or help from others. I am very keen to learn and develop new skills. I welcome any constructive criticism when needed and act on the advice appropriately.

How do you think you can contribute towards the needs and the independence of a disabled person?

I will always encourage the independence of an individual and aid them in completing tasks if required. I will always support other to reach their full potential and help them to learn and develop new skills. I identify that every person is different and have different limitations and abilities

What is it about PA work which appeals to you?

I enjoy helping others enjoy life and get the best quality of life possible. I enjoy making new friends and getting to know people.

What are your hobbies/interests?

I enjoy spending time outdoors doing various activities, I also enjoy listening to music going to concerts and to the theatre. I have enjoy going to the cinema and going out for food with friends. In my spare time I do a lot of reading

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?

After school and weekends

Are there any circumstances which would prevent you from providing cover or swapping a shift?

No

Would you like to expand on the answers given above? Please use the box below.

N/A

Name

Title

Address

Phone

In what capacity do you know this person (should not be a family member)?

Name

Title

Address

Phone

In what capacity do you know this person (should not be a family member)?

Rehabilitation of Offenders Act 1975 * Within the nature of the work for which you are applying this position is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1975 (Exemptions Order). Applicants are therefore not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of this Act. In the event of employment, any failure to disclose such convictions could result in dismissal. Information given is confidential and will only be considered for the purposes of the application. If there is any such information you wish to provide?

No

The organisation will hold your data on file for twelve months after the end of the relevant recruitment process if you provide consent. The purpose of retaining your data with your consent is to allow you to apply easily for other jobs we may have available. At the end of the twelve months period you will be required to complete a new application form in order to remain on our system. You may withdraw your consent for us to hold your data at any time after the initial recruitment process is completed. I consent for my personal data to be held and agree that Dewis CIL may keep this application form on file for twelve months. It may be used for future prospective employers. I understand that you will contact me in due course should any such person make themselves known to you.

Yes

I agree that there is nothing which would prevent me from doing this job.

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, Merthyr

Please indicate the approximate times that you are available for work throughout the week.

  Early Morning

·         Saturday

·         Sunday

  Late Morning

·         Saturday

·         Sunday

  Early Afternoon

·         Saturday

·         Sunday

  Late Afternoon

·         Saturday

·         Sunday

  Evenings

·         Monday

·         Tuesday

·         Wednesday

·         Thursday

·         Friday

·         Saturday

·         Sunday