Personal Assistant Application Form Submission 

Title *:. 
First Name *: 
Address 1 *:  
Address 2: 
Town *: Mountain Ash 
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. *: I have experience in working with a person who has a brain Injury as I do it on a daily basis as my brother and am currently one on his private carers, I also work in a leisure centre and have seen people from all walks of like, and understand how different people have different needs. 
What qualities do you think are important when working as a personal assistant with a disabled person? *: I think is important to be calm, make sure there are rules that are followed, to be confident and kind, ensure the safety of service user and be supporting and comforting and somebody that can be relied on. 
How do you think you can contribute towards the needs and the independence of a disabled person? *: I think its important to help a disabled person as much as you can however allow them to also have thier own independence when under taking activity and encourage them to do so 
What is it about PA work which appeals to you? *: I have a brother who has a brain Injury and my family have had so much help its important to be to be able to help others the way I have been because I know how difficult it can be to have different people back forth a person life 
What are your hobbies/interests?: I enjoy wildlife as I have a degree in biology walking my dog, swimming and exercising also I am a qualified swimming teacher and gym instructor 
Would you consider a casual position if you are unsuccessful with this job? *: No 
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? *: Any day or nights expect wednesday 
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)? *: Employer 
Name *:  
In what capacity do you know this person (should not be a family member)? *: Ive known this person for 5 years as he was my manger whilst working in sports centre 
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?: Any 
How many hours of work can you offer per week?: 37 hours 
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