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Personal Assistant Application Form Submission

Title *: Mrs.
First Name *:
Last Name *:
Address 1 *:
Address 2: Caerphilly
County *:
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 as a carer for almost 3 years but have been caring for my father for 12 years. Although many of my clients are half hour visits I enjoy the longer calls such as 2 hour sits where a relationship can develop.

What qualities do you think are important when working as a personal assistant with a disabled person? *: Patience and understanding are important as is a genuine desire to make a positive influence on someones life. A friendly, caring and honest character and ability to put people at ease is also important.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I believe that I have gained experience of assisting people with mental and physical disabilities through looking after my father and by working as a carer helping people to stay independent for as long as possible.

What is it about PA work which appeals to you? *: I believe that PA work would be more varied than the care work I presently do. Also I would be concentrating on one person so could build a good rapport with my employer.

What are your hobbies/interests?: Ballroom dancing. Reading. Occasionally socialising with friends or 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? *: Most days or evenings are ok but I need a little notice.

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.: As I am a carer for my father my hours of work are restricted by the amount I can earn.

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?: 10 mile radius of Caerphilly

How many hours of work can you offer per week?: Approx 12

Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Tuesday PM/Tuesday Overnight/Wednesday AM/Wednesday PM/Wednesday Overnight/Thursday AM/Thursday PM/Thursday Overnight/Friday AM/Friday PM/Friday Overnight/Saturday AM/Saturday PM/Saturday Overnight/Sunday AM/Sunday PM /Sunday Overnight/
Further Information: My hours are restricted because of the amount I am allowed to earn