Personal Assistant Application Form Submission

Title *: 

First Name *: 

Last Name *: 

Address 1 *: 

Address 2: 

Town *: Rhoose

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. *: I currently work at beechwood college in sully, I have worked there for 4 years. I have worked as an LSA supporting day students who come to the college and also as a support worker.

What qualities do you think are important when working as a personal assistant with a disabled person? *: To be patient, kind, caring, companionate.

How do you think you can contribute towards the needs and the independence of a disabled person? *: Allowing choice, socialising with groups, strongly encourage interaction, going out into the community.

What is it about PA work which appeals to you? *: Helping improve quality of life and giving emotional support.

What are your hobbies/interests?: I have two young children (boys) who keep me very busy. I go to a lot of playgroups and baby classes.

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? *: Monday morning or A weekend day

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.: My partner works shifts so on his time off I can happily cover or work overtime when needed
Name *:s

Job Title *: 

Address *: Phone Number *: 

In what capacity do you know this person (should not be a family member)? *:
Name *:

Job Title *: 

In what capacity do you know this person (should not be a family member)? *: Old work colleague now friend

Is 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. *: 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?: Vale of glamorgan
How many hours of work can you offer per week?: 16

Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Saturday AM/Sunday AM/
Further Information: