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Personal Assistant Application Form Submission

Title *: Miss.
First Name *:
Last Name *:
Address 1 *:
Address 2:
Town *: Barry
County *: Vale of 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. *: NVQ level 3 health and social care Also have had training Epilepsy Health and safety Medication Infection control Have worked along side professionals regards behaviour issues

What qualities do you think are important when working as a personal assistant with a disabled person? *: I have worked within the care sector for 16 years, I have worked with different kinds of disabilities, such as learning disabilities, autism, mental heath and much more, Treat everyone as an individual and to their own needs.

How do you think you can contribute towards the needs and the independence of a disabled person? *: Working towards care plans, listening and equality to ensure the best care needs.

What is it about PA work which appeals to you? *: I always feel Im a caring person that to likes to help others and try to assist in anyway I can, its also rewarding knowing Ive helped someone and helping them live the best life they can.

What are your hobbies/interests?: I enjoy socialising, and spending time with my two children and family.

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? *: No

What days/nights are you able to work, or prefer to work? *: During 10am and 2pm Monday to Friday can be available weekends for a few hrs

Are there any circumstances which would prevent you from providing cover or swapping a shift? *: No

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)? *:

If there is any such information you wish to provide? *: No

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?: Barry Rhoose

How many hours of work can you offer per week?: 10

Please indicate the approximate times that you are available for work throughout the week.:
Further Information: Possibly during 10am amd 2pm due to childcare and school runs