Personal Assistant Application Form Submission 

Title *: 
First Name *: 
Last Name *: 
Address 1 *: 
Address 2:
County *: Mid Glamorgan 
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. *: Ive 20 years experience within the care/support sector(with RCT council). I have worked independently and as a pair with clients who required more assistance. Food prep, medication assisting with personal care etc. 
What qualities do you think are important when working as a personal assistant with a disabled person? *: Personal care must always be treated with dignity, to make that person feel at ease and also feel they can trust you, to listen to what they require and perhaps sometimes suggest other options... To be their friend...... 
How do you think you can contribute towards the needs and the independence of a disabled person? *: Id always listen to what the clients needs are, try to encourage them to be as independent as much as they can or what to be.. Also being aware of situations in house or out and about that could put that client in danger... 
What is it about PA work which appeals to you? *: Loved working in home care, Ive also worked as a PA quite some years ago with a lady ... All be it only a 4hour a week, but we became great pals until she passed away. 
What are your hobbies/interests?:Reading... Films and walking... Just lately started cycling... Oh and the odd cooking day!! 
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? *: Days only 
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.: 
Name *: 
In what capacity do you know this person (should not be a family member)? *: 
In what capacity do you know this person (should not be a family member)? *: My old supervisor 
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?: Maerdy-to-Porth 
How many hours of work can you offer per week?: 16 hours max 
Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Tuesday AM/Wednesday AM/Thursday AM/Friday AM/ 
Further Information: