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Personal Assistant Application Form Submission

Title *: Miss.
First Name *:
Last Name *:
Address 1 *:
Address 2:
Town *: Cardiff
County *: Cardiff
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 have experience in caring solely for a disabled person. I am used to doing personal care, feeding, dressing, securing safely in wheelchair, pushing wheelchair, traveling on public transport with a wheelchair, engaging with and including the disabled person.

What qualities do you think are important when working as a personal assistant with a disabled person? *: To include the disabled person, to give them choices, show them respect and protect their dignity, to have fun but always to keep safe.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I can help them accessing their community, allow them to make decisions about their day and help them to achieve to the best of their ability

What is it about PA work which appeals to you? *: I have a lot of energy and compassion. I am not afraid of disability and would always stand up for their rights in public. I want to make a difference in somebody’s life. PA work appeals to me as I like to be active and spending time in other’s company

What are your hobbies/interests?: I am active, enjoying trampolining, skiing, swimming and music. I love animals and children

Would you consider a casual position if you are unsuccessful with this job? *: No

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? *: Evenings and weekends

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.: I am still in full time education but would be looking to work during the holidays and weekends

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).: No

What geographical area’s are you able to cover?: Cardiff

How many hours of work can you offer per week?: 6 - 10 hours
Further Information: I would be looking to work with CDP632 when she is home from college whenever needed