264RCT Personal Assistant Application Form Submission Title *:. First Name *: Last Name *: Address 1 *: Town *: Pontyclyn County *: Wales Postcode *: Phone number *: Please enter your email address for submission confirmation. *: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. *: I looked after my mum for 2years full time she had dementia needed help with everything.Thats why I decided to be a carer to help and support people who need the help care and companionship they ask for.I then took a job with a company helped there I had to leave to look after my granddaughter but now she’s in school,would love to help someone in need again. What qualities do you think are important when working as a personal assistant with a disabled person? *: I’m am a very patient kind person punctual love chatting.Understand people need there privacy at all times very understanding to people’s needs in this situation.i am very aware of people’s privacy at all times.i loved looking after my mum wanted to help others who need it.Always treat people in confidence at all times.I care very much . How do you think you can contribute towards the needs and the independence of a disabled person? *: Confidence,privacy,careing,understanding,kind,always ready to help. What is it about PA work which appeals to you? *: I enjoy get a lot of satisfaction from helping people who need me alway treat people the way you always would want to be treated yourself. What are your hobbies/interests?: My grandchildren are a huge part of my life.Watching films I also use my sons running machine to keep fit. 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? *: Any night school time days and all school holidays. Are there any circumstances which would prevent you from providing cover or swapping a shift? *: No If you would like to expand on the answers given above? Please use the box below.: I have a lot to give to someone in need. Name *: In what capacity do you know this person (should not be a family member)? *: Neighbour 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?: Llantrisant lanharan pontyclyn pencoed How many hours of work can you offer per week?: 25 Please indicate the approximate times that you are available for work throughout the week.: Monday PM/Monday Overnight/Tuesday AM/Tuesday PM/Tuesday Overnight/Wednesday Overnight/Thursday AM/Thursday PM/Thursday Overnight/Friday Overnight/Saturday AM/Saturday PM/Saturday Overnight/Sunday Overnight/ Further Information: Would love to help the vulnerable.