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Personal Assistant Application Form Submission

Title *: Mrs.
First Name *:
Last Name *:
Address 1 *:
Address 2:
Town *: Taffs Well
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 retired nurse I live very near the lady I love dogs I am very active and love walking dogs

What qualities do you think are important when working as a personal assistant with a disabled person? *: As a retired nurse I have a lot of experience working with both physically and emotional clients I have worked with adults and children and have attended lots of courses moving and handling etc

How do you think you can contribute towards the needs and the independence of a disabled person? *: Independent is very important and I feel I could help promote this by helping with dog walks and any activity the lady would like to do and company is equally important

What is it about PA work which appeals to you? *: We both love dogs the lady live very near to me I am of a similar age and I have years of experience

What are your hobbies/interests?: I run a livery yard I love all animals a love of our local countryside enjoy dog walks swimming visits to garden centres shops coffee shops

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? *: Would prefer weekdays but could do some weekends could work days or nights

Are there any circumstances which would prevent you from providing cover or swapping a shift? *: No

If you would like to expand on the answers given above? Please use the box below.: Have years of experience

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?: Within 1o mile radius

How many hours of work can you offer per week?: Up to 15 hrs

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

Further Information: Would prefer weekday shift but could do weekend nights or some weekend work