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Personal Assistant Application Form Submission

Title *: Ms.
First Name *:
Last Name *:
Address 1 *:
Address 2:
Town *: Rhiwbina
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 am a friendly, patient, organized individual. For the past 5years I have worked as a PA for clients who have differing needs and health issues –including MS, ME, CFS, physical disabilities, mental health problems. Over the five years I have usually worked for more than one individual at any one time, including one individual who employed me for five years, until she recently moved out of the area. In my different positions I have helped with personal care, shopping, medical appointments, socializing & accessing the community, domestic tasks and preparing meals for individuals with specific dietary requirements. From 2000 – 2014 I recruited volunteers for a small, local charity which assisted the elderly and the disabled in the local community with everyday tasks. I also organized two lunch clubs for over seventy individuals. Whilst in this position I attended a Food Hygiene course I have my own car and a full, clean driving license. I am flexible with the hours I can work, but would prefer block hours. I would like about eight regular hours per week but I am happy to work more than this if extra cover is required. I am available Wednesdays (all day), Thursdays am and Friday am and also occasional Mondays and Tuesdays.

What qualities do you think are important when working as a personal assistant with a disabled person? *: Patient, friendly, non-judgemental, aware of confidentiality.

How do you think you can contribute towards the needs and the independence of a disabled person? *: Over twenty year experience of working with individuals with various, diverse health issues, the elderly and disabled.

What is it about PA work which appeals to you? *: Helping to improve an individual’s quality of life.

What are your hobbies/interests?: Swimming, cooking, walking, going to the theatre, travelling.

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? *: Wednesday, Thursday am, Friday am

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.: sometimes available on Monday & Tuesday

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? *: Yes

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?: North Cardiff

How many hours of work can you offer per week?: 8

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

Further Information: Occasional Mondays