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Personal Assistant Application Form Submission

Title *: Miss.
First Name *:
Last Name *:
Address 1 *:
Address 2:
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. *: I am very patient, caring and calm. I am able to assit with dressing, reducing the risk of bed sores and feeding

What qualities do you think are important when working as a personal assistant with a disabled person? *: I believe that personal assistants should be kind, caring, patient, reliable and calm when assisting a disabled person. These qualities are ones that i possess.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I am able to help them socialise, ensuring that their basic needs are met and that they are happy and content within their own home.

What is it about PA work which appeals to you? *: I enjoy helping other and have a kind and caring disposition. I believe the personal assistant role would suit my skillset.

What are your hobbies/interests?: I enjoy spending time with friends, walking and reading books.

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? *: I prefer to work days. between the hours of 9am-2pm

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.: If my children are unwell.

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?: Buetown, Canton, Grangetown and Riverside

How many hours of work can you offer per week?: 16

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/