78VOG Personal Assistant Application Form Submission Title *: Mrs.First Name *: Last Name *: Address 1 *: Address 2: Town *: BarryCounty *: Vale of GlamorganPostcode *: CF62 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. *: YesPlease 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. *: VCRS Barry Hospital - Reablement Community Support Worker Mrs Alison Roberts Penarth - Live in carer Dementia Care Palliative Care Manual Handling Personal Care What qualities do you think are important when working as a personal assistant with a disabled person? *: Sensitivity Compassion Equality Trust Calm Positivity motivation Flexibility Mindfulness Encouragement Respect Confidence Equanimity Acceptance Trust How do you think you can contribute towards the needs and the independence of a disabled person? *: Safeguarding Assistance as and when required Space and choices Promoting Independence Encouragement Focus on Abilities Help and support with care Inclusion Availability of own choices What is it about PA work which appeals to you? *: Giving independent care directly sometime to one person, monitoring healthy eating, administering medication to enable the individual to keep safe. Getting to know the individual over a time Supporting daily life -Independent living, personal care, household tasks, shopping, social activities, financial support. Safeguarding Rehabilitation CaringWhat are your hobbies/interests?: Reading walking Socialising Family Would you consider a casual position if you are unsuccessful with this job? *: YesDo you drive? *: YesAre you a vehicle owner? *: YesDo you smoke? *: NoAre you able to undertake training? *: YesWhat days/nights are you able to work, or prefer to work? *: Monday - FridayAre there any circumstances which would prevent you from providing cover or swapping a shift? *: YesIf you would like to expand on the answers given above? Please use the box below.: Respite careIn what capacity do you know this person (should not be a family member)? *: Long Standing FriendIs there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? *: No/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 GlamorganHow many hours of work can you offer per week?: Please indicate the approximate times that you are available for work throughout the week.: Further Information: Currently working 1 week a month therefore working hours to be discussed and arranged.