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Personal Assistant Application Form Submission

Title *: Miss.
First Name *:
Last Name *:
Address 1 *:
Address 2: St mellons
Town *: Cardiff
County *: South 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. *: At present I am a support worker & have experience in domicilary care. I have worked with various service users over the years. I also have have health & social care nvq 2

What qualities do you think are important when working as a personal assistant with a disabled person? *: To be very patient & understanding

How do you think you can contribute towards the needs and the independence of a disabled person? *: By making them feel safe & Independant in their own home

What is it about PA work which appeals to you? *: I enjoy assisting with other people’s needs

What are your hobbies/interests?: I enjoy spending time with my family & going out to bingo occasionally

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? *: Yes

Are you able to undertake training? *: Yes

What days/nights are you able to work, or prefer to work? *: Mon weds Friday

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 already work for 3 service users on a part time basis & would have to commit to their needs firstly however only work for them part time

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
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?: St mellons Rumney llanrumney

How many hours of work can you offer per week?: 10

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