Personal Assistant Application Form Submission 

Title *: Mr. 
First Name *:  
Address 2: 
Town *: Mountain Ash 
County *: RCT 
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. *: 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. *: My previous emplyment is with the former employment service. My experience is careing for my own autistic son for 22 years ,hes now decided to live inderpendantly. 
What qualities do you think are important when working as a personal assistant with a disabled person? *: pathence,understanding of there needs,building there confidencehas there vulnerable. my own son has similar problems, and over the yearsi have learnded how to understand his needs and anticipate and solve any problems. 
How do you think you can contribute towards the needs and the independence of a disabled person? *: i have done thiswith my own for 22 years, i can handle minor mealtdowns, and solve most problems with a smile. 
What is it about PA work which appeals to you? *: varitey of meeting and working with folk I can healp,has been there with my own son. 
What are your hobbies/interests?: walikng, cinema, bowling,history, reading, music,nature 
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? *: Yes 
Are you able to undertake training? *: No 
What days/nights are you able to work, or prefer to work? *: 16 plus 
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.: am easy as regards this 
Name *: 
Phone Number *: 
In what capacity do you know this person (should not be a family member)? * 
Name *: 
In what capacity do you know this person (should not be a family member)? * 
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?: aberdare, abercynon,, cilfynidd, ynysybwl 
How many hours of work can you offer per week?: to suit 
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/Thursday AM/Thursday PM/Friday AM/Friday PM/Saturday AM/Saturday PM/Sunday AM/Sunday PM / 
Further Information: happy to learn new skills has required,non smoker,gooid sense of humour