Title 

First Name 

Last Name 

Address 1 

Address 2 

Beddau 

Town 

Pontypridd 

County 

Mid Glamorgan 

Post Code 

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 

currently working for New Directions for last 2 years and support an 8yr old boy with autism. 
due to recently moving to Beddau i am finding that commuting to cardiff for shifts is proving too much.  
so i am looking to continue my support role closer to home. 

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

i am compassionate, caring ,reliable and thoughtful. i do my best to consider places where i know they will enjoy if they havent asked and i am energetic and able to keep up. 

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

i am fun person and thoroughly enjoy engaging with people to ensure they have a good time and safe. 

What is it about PA work which appeals to you? 

i am already a support worker, looking for clients closer to home. 

What are your hobbies/interests? 

i am a dog walker in the daytime and also own a horse, but i do not ride anymore. i love arts and crafts, anything to do with animals, enjoy cinema and getting out and about. 

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? 

evenings and weekends 

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

Yes 

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

i am a dog walker in the daytime mon to fri so wouldnt be able to cover during hours of 9am till 3pm 

Name 

Title 

Address 

Phone 

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

Name  

Title 

Address 

 

Phone  

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 

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

Yes 

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 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? 

beddau,church village,llantwit fardretontegtalbot green, llantrisant. 

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

  Late Morning 

  • Saturday 
  • Sunday 

  Early Afternoon 

  • Saturday 
  • Sunday 

  Late Afternoon 

  • Monday 
  • Wednesday 
  • Friday 
  • Saturday 
  • Sunday 

  Evenings 

  • Monday 
  • Tuesday 
  • Wednesday 
  • Thursday 
  • Friday 
  • Saturday 
  • Sunday 

  Overnights 

  • Friday 
  • Saturday