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Personal Assistant Application Form Submission

Title *: Mrs.
First Name *:
Last Name *:
Address 1 *:
Address 2:
Town *: Cardiff
County *: Wales
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. *: Adult Workforce Activities Helper Care - January 2020-up to present Gap Year - February 2019-December 2019 due to Chronic Back Pain Bank HCSW In Cardiff & Vale University Health Board - November 2015-January 2019 Relief Support Worker - Dimension LTD (People with Learning Disabilities) - February 2012-October 2015 Senior Carer - Southern Cross Healthcare - January 2007- January 2012 Senior Carer - Meadows Nursing Home - April 2006-January 2007 Qualified Nurse - Quezon Medical Center Philippines - February 2002-January 2006 Welfare Officer -Christalite Methodist Home Singapore - December 1999-November 2001

What qualities do you think are important when working as a personal assistant with a disabled person? *: The ability to understand the challenges faced by disabled people and treat them with respect and dignity. You must have the ability to develop a strong, trusting relationship with your service user regardless of race and faith.

How do you think you can contribute towards the needs and the independence of a disabled person? *: Empower your loved one to make decisions and actively involve him in decision making. Promotion of a persons independence entails providing opportunities for the person to maintain a better quality of life. Trust others and build a support network on the community.

What is it about PA work which appeals to you? *: The role of PA is extremely varied and no to jobs will ever be the same. This is because the individual employer can choose exactly how they want you to support them. You may be supporting them at their place of work or education, to maintain hobbies and interests, by carrying out household tasks and any other activities to help them develop as a person.

What are your hobbies/interests?: zumba singing going to the cinema church activities shopping watching tv internet surfing

Would you consider a casual position if you are unsuccessful with this job? *: Yes

Do you drive? *: No

Are you a vehicle owner? *: No

Do you smoke? *: No

Are you able to undertake training? *: Yes

What days/nights are you able to work, or prefer to work? *: days - prefer for 1 call only a day with minimum of 6 hours I can do night as well depends on the needs of my service user.

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 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?: Llanedeyrn Pentwyn Pontprennau Cyncoed Pennylan Roath

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

Please indicate the approximate times that you are available for work throughout the week.:

Further Information: I prefer to work with 1 call per day 16 hours a week and looking for an Employer with a minimal assistance due to my back pain, without any heavy lifting. Thank you for giving me a kind consideration to my application.