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Personal Assistant Application Form Submission

Title *: Mrs.
First Name *:
Last Name *:
Address 1 *:
Address 2:
Town *:
County *: South glamorgan
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. *: Mrs Ann Rimell I look after Ann’s husband Gethin who has a brain injury through an accident over 20 years ago. I have worked with Gethin for over 8 years, we go out in his car for days out shopping lunch etc. I have spent time with him in Hen Goleg day center and also Headway. I have also cared for others including my grandmother who lived with me in her nineties.

What qualities do you think are important when working as a personal assistant with a disabled person? *: I understand a lot of the issues associated with brain injury and how it can affect everyday life . I studied Holistic therapy a few years ago and also counselling.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I’m a good listener, enjoy my job and like to encourage my client to be as independent as possible whilst still being there for him. We choose things he likes to do, plan routes and making sure things are safe for him to do . I think it is important in life to be non judgemental of others and treat others as individuals

What is it about PA work which appeals to you? *: I believe in having a one to one relationship with my client rather than having several people coming and going also being able to get on and have conversations ect

What are your hobbies/interests?: I enjoy looking after others I have fours dogs who I adore and love all animals I enjoy reading music and driving I enjoy learning new things and would like to do some more courses to help with my job

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? *: Thursday Saturday and Sunday Also some evenings

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 look after my other client four days a week

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 cautions or convictions which will appear on your mandatory DBS check? *: 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?: Barry Penarth Cardiff

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.: Thursday AM/Thursday PM/Saturday AM/Saturday PM/Sunday AM/Sunday PM /
Further Information: I own a car and have business class insurance