Personal Assistant Application Form Submission


Title *: 
First Name *: 
Last Name *: 
Address 1 *: 
Address 2:
Town *: Pentre
County *: Rhondda cynon taff
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. *: 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 qualification
What qualities do you think are important when working as a personal assistant with a disabled person? *: Empathy,sympathy,confidence,confidentiality,dignity
How 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 confidence
What is it about PA work which appeals to you? *: I am already a PA and am looking for more hours during the week
What are your hobbies/interests?: Going for drives,shopping,reading i also enjoy a game of bingo
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? *: Yes
What days/nights are you able to work, or prefer to work? *: Monday-friday
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.: I have another job as a PA which takes up all of my weekend and some time through the week
Name *: 
In what capacity do you know this person (should not be a family member)? *: Employer
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?: Rhondda cynon taff
How many hours of work can you offer per week?: Depending on days up to 25
Please 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: