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Personal Assistant Application Form Submission

Title *: Mrs.
First Name *:
Last Name *:
Address 1 *:
Address 2:
Town *: Cardiff
County *: UK
Postcode *:
Phone number *:
Please enter your email address for submission confirmation. *:

Reference number of job being applied for *:

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 have four children and my in laws who I have been caring for the last 19 years providing them support to live independently.

What qualities do you think are important when working as a personal assistant with a disabled person? *: I am caring and a good cook and keep my house nice and clean. I check their medication, appointment, their food and clothes. I have good communication skills to talk to them in Bengali.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I support them by cleaning their room, kitchen and living space. I cook and serve them meals. Iron their clothes and change their beds, I also take them out for walks. I have cared my sister in law who was suffering from severe learning disability and epilepsy.

What is it about PA work which appeals to you? *: I speak shyletti and Bengali and like working in the community to support others.

What are your hobbies/interests?: I like reading books, going for walks and gardening in summer and listening to music.
Would you consider a casual position if you are unsuccessful with this job? *: Yes

Do you drive? *: No

Are you a vehicle owner? *: No

Do you smoke? *: No

Are you able to undertake training? *: Yes

What days/nights are you able to work, or prefer to work? *: Weekdays during school hours.

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.:
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?: Within Cardiff

How many hours of work can you offer per week?: 6-7 hours