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Personal Assistant Application Form Submission

Title *: Miss.
First Name *:
Last Name *:
Address 1 *:
Address 2:
Town *: Bridgend
County *: Mid 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. *: I have worked in the care sector for over 20 years and i have gained QCF Level 2,3 and 5 in Adult management. I am currently working a s a Domiciliary Care Manager and i am registered with social care wales. I am looking to take on a more personal role and provide care at the highest possible standard.

What qualities do you think are important when working as a personal assistant with a disabled person? *: A good understanding of the clients condition. Patience and being able to build a positive outcome for the client. Listening and building trust with the client.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I have worked in the sector for a long time and gained experience in various complex situations. I am friendly and approachable, reliable and trustworthy.

What is it about PA work which appeals to you? *: To provide a high quality standard of care. To build positive outcomes.

What are your hobbies/interests?: I am interested in astronomy and history. i watch a lot of documentaries and i enjoy spending time with friends and family.

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? *: Day work preferably but can be flexible if required

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.:
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)? *:

Is there is any such information you wish to disclose relating to any convictions? *: 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?: Cardiff

How many hours of work can you offer per week?: 20 – 40

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