Personal Assistant Application Form Submission 

Title (required):  
First Name (required):  
Address 2: 
Town (required): Tonypandy 
County (required): Rhondda Cynon Taff 
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 7 GCSE 4 are health and social I currently work as a community care worker in RCT Worked there for 16 months so have experience in personal care in adults I also know this individual as I am a carer that goes to the home 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): You must be a very calm and patient person to work as a PA A very caring, Sensitive person to other peoples needs and emotions As I work in care I believe that I am those things 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): Its all about going the pace of the individual, its not over wheleming them with a lot of tasks and not setting the person up to fail.. its all about breaking things down in to steps for them Its about doing things that they will find interesting and what they enjoy to do or watch 
What is it about PA work which appeals to you? (required): What appeals to me as a PA is working with the one individual, giving all your time and attention on that one person, seeing the individual going from strength to strength and getting to know them on a deeper level finding out what that person enjoys to do and what are thier interests and hobbies are Working closer with the person and for that person to be comfortable with me 
What are your hobbies/interests?: As I am a mum of 2 children my hobbies and interests are enjoying time with them, long walks.. going to the beach and having lots of fun I also like to make time for friends and family I am a very sociable person 
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): The hours that include in this role are fine 
Are there any circumstances which would prevent you from providing cover or swapping a shift? (required): Yes 
If you would like to expand on the answers given above? Please use the box below.:As I am a mum of 2 children if there was any swapping ot changes in the times. Just need to know time in advance 
Name (required):  
In what capacity do you know this person (should not be a family member)?  (required): 
Name (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?: All of rct 
How many hours of work can you offer per week?: Up to 20 
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 /