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Personal Assistant Application Form Submission

Title *: Ms.
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. *: I have a medical science degree from Sudan 2004 and I have a postgraduate diploma in healthcare studies ( graduated September/2019) which gives me knowledge about a wide range of health problems and diseases and make me understand some of the challenges arising from certain health issues.

What qualities do you think are important when working as a personal assistant with a disabled person? *: Being patient, understanding and respectful.

How do you think you can contribute towards the needs and the independence of a disabled person? *: By giving them the choice to contribute to planing their own care. Listening to their wishes and incorporate it in their care plan is a key to promote their independence. Treating them with dignity as individual to promote their confidence.

What is it about PA work which appeals to you? *: Helping people and caring for someone and the rewarding nature of the job when I make a difference to a person’s life.

What are your hobbies/interests?: Reading, walking, cinema and recently I started bowling with my little son who loves it.

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’m flexible

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?: St Mellons, Rumney, Llanrumny, Tremorfa, Splot, Admsdown, Roath, Penylan,Llandren, Heath, and Cathays.

How many hours of work can you offer per week?: 24

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/Sunday AM/Sunday PM /
Further Information: I can do overnight shifts if necessary.