278RCT Personal Assistant Application Form Submission Title *: First Name *: Last Name *: Address 1 *: Address 2:Town *: PentreCounty *: Rhondda cynon taffPostcode *: 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. *: YesPlease 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 obtained gcse whilst at comprehensive school i also have vast experience working in a social care setting which include assisting individuals in their own home and also in a residential setting where i gained a level 3 health and social care qualificationWhat qualities do you think are important when working as a personal assistant with a disabled person? *: Empathy,sympathy,confidence,confidentiality,dignityHow do you think you can contribute towards the needs and the independence of a disabled person? *: I will try an promote as much independence as possible without compromising the individuals self esteem or confidenceWhat is it about PA work which appeals to you? *: I am already a PA and am looking for more hours during the weekWhat are your hobbies/interests?: Going for drives,shopping,reading i also enjoy a game of bingoWould you consider a casual position if you are unsuccessful with this job? *: YesDo you drive? *: YesAre you a vehicle owner? *: YesDo you smoke? *: YesAre you able to undertake training? *: YesWhat days/nights are you able to work, or prefer to work? *: Monday-fridayAre there any circumstances which would prevent you from providing cover or swapping a shift? *: YesIf you would like to expand on the answers given above? Please use the box below.: I have another job as a PA which takes up all of my weekend and some time through the weekName *: In what capacity do you know this person (should not be a family member)? *: EmployerIs 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. *: YesI consent to the above *: YesI agree that the information I provide will be posted to the Dewis CIL PA noticeboard (all personal information will be withheld).: YesWhat geographical area’s are you able to cover?: Rhondda cynon taffHow many hours of work can you offer per week?: Depending on days up to 25Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Monday Overnight/Tuesday AM/Tuesday PM/Tuesday Overnight/Wednesday AM/Wednesday PM/Wednesday Overnight/Thursday AM/Thursday PM/Thursday Overnight/Friday AM/Friday PM/Friday Overnight/Further Information: