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Personal Assistant Application Form Submission

Title *: Mrs.
First Name *:
Last Name *:
Address 1 *:
Address 2:
Town *: Cowbridge
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. *: Through out my working experience, I have worked with children and young adults with learning and physical disabilities. While my children were growing up I was a registered Childminder. I worked for Sure Start in Ely Cardiff for two years which I found very rewarding. I then went on to work at Y Bont which is a School for children with complex needs.

What qualities do you think are important when working as a personal assistant with a disabled person? *: Patience ,communication, enthusiasm and I am able to keep calm in an emergency .

How do you think you can contribute towards the needs and the independence of a disabled person? *: All of the above plus I have a calming and helpful nature

What is it about PA work which appeals to you? *: Being able to give the individual the ability to be independent.

What are your hobbies/interests?: Pilates, yoga, I love to be out in the fresh air and gardening .

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? *: I can do weekdays only however I dont mind doing a Saturday when needed.

Are there any circumstances which would prevent you from providing cover or swapping a shift? *: Yes

If you would like to expand on the answers given above? Please use the box below.: Only if my elderly mother needs taking to an appointment.

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. *: No

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).: No

What geographical area’s are you able to cover?: Vale of Glamorgan

How many hours of work can you offer per week?: Between 15 to 20

Please indicate the approximate times that you are available for work throughout the week.: Tuesday AM/Tuesday PM/Wednesday AM/Wednesday PM/Thursday AM/Friday AM/Saturday AM/

Further Information: I dont mind doing every other Saturday.