58VOG Personal Assistant Application Form Submission Title *: Mrs. First Name *: Last Name *: Address 1 *: Address 2: Town *: Barry County *: Wales Postcode Phone number *: Please enter your email address for submission confirmation. *: Reference number of job being applied for *: Vog625 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’ve worked with a disabled man who has angle syndrome What qualities do you think are important when working as a personal assistant with a disabled person? *: Someone who is kind willing to help and enjoy what they do How do you think you can contribute towards the needs and the independence of a disabled person? *: I’m hard working willing to do what ever is needed What is it about PA work which appeals to you? *: I loved working with the lad I was with and I like the one to one What are your hobbies/interests?: Spending time with my kids 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? *: No Are you able to undertake training? *: Yes What days/nights are you able to work, or prefer to work? *: Any time 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 *: Job Title *: Address *: Phone Number In what capacity do you know this person (should not be a family member)? Name *: Job Title *: Address *: Phone Number In what capacity do you know this person (should not be a family member)? *: Family friend If there is any such information you wish to provide? *: Yes 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?: Vale of Glamorgan How many hours of work can you offer per week?: 20Please indicate the approximate times that you are available for work throughout the Week.