Personal Assistant Application Form Submission 

Title (required):  
First Name (required): 
Last Name (required): 
Address 1 (required)
Address 2:  
Town (required): Aberdare 
County (required): Mid Glamorgan 
Postcode (required):
Phone number (required): 
Please enter your email address for submission confirmation. (required): 
Reference number of job being applied for (required):  
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. (required): 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. (required): I have worked in care for 30 plus year both in nursing, residential homes and out in the community with adults and children. Also with mental health clients. I am always looking to gain more experience in these sectors and will always be keen to do ongoing training. 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): I think it is very important to be non judgemental at all times, to be patient and understanding, to have empathy, to listen and let the person express their feelings and let the client do what they like to do at all times. 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): I think I can make a disabled person have a much better brighter future as I am patient, non judgemental and I know the importance of making people fee valued and respecting their opinions. 
What is it about PA work which appeals to you? (required): I have worked in the care sector for 30 plus years in lots of different settings i.e. in nursing homes and out in the community both with adults and children. I have worked with mental health clients also. I love this kind of work, I love seeing my clients glow when they become more independent. 
What are your hobbies/interests?:I love animals, especially dogs and that is my passion walking my dog. I also cycle and I love cooking and baking. 
Would you consider a casual position if you are unsuccessful with this job? (required): Yes 
Do you drive? (required): Yes 
Are you a vehicle owner?  (required): Yes 
Do you smoke? (required): No 
Are you able to undertake training? (required): Yes 
What days/nights are you able to work, or prefer to work?  (required): I would prefer to work day shifst but I am open to other shifts 
Are there any circumstances which would prevent you from providing cover or swapping a shift? (required): No 
If you would like to expand on the answers given above? Please use the box below.: 
Name (required): 
Address (required): . 
Phone Number (required): 
In what capacity do you know this person (should not be a family member)?  (required):
Address (required): . 
Phone Number (required):  
In what capacity do you know this person (should not be a family member)?  (required):  
Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? (required): No/ 
Please provide details if necessary: 
I agree that there is nothing which would prevent me from doing this job. (required): Yes 
I consent to the above (required): 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?: RCT Merthyr Tydfil 
How many hours of work can you offer per week?: 16 plus a week 
Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Tuesday AM/Tuesday PM/Wednesday AM/Wednesday PM/Thursday AM/Thursday PM/Friday AM/Friday PM/Saturday AM/Saturday PM/Sunday AM/Sunday PM / 
Further Information: