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Personal Assistant Application Form Submission

Title *: Miss.
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 *:

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. *: In my Home, My elder brother is disable so i have a good experience how to cooperate and help a disable person.

What qualities do you think are important when working as a personal assistant with a disabled person? *: Working as a personal assistant of a disable person it is really important to make a good understanding and strong bonding with the person so that they can fully trust you. we have to be very carm and polite

How do you think you can contribute towards the needs and the independence of a disabled person? *: I can be his or her right hand.

What is it about PA work which appeals to you? *: Personal Assistance is like giving all your concern to the person you are assisting with all the concentration and with patience

What are your hobbies/interests?: I love cooking and listening songs

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

Do you drive? *: Yes

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? *: except tuesday evening and thusday

Are there any circumstances which would prevent you from providing cover or swapping a shift? *: No

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)? *:

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?: Cardiff

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

Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Monday Overnight/Tuesday AM/Tuesday Overnight/Wednesday AM/Wednesday PM/Thursday Overnight/Friday AM/Friday PM/Friday Overnight/Saturday AM/Saturday PM/Saturday Overnight/Sunday AM/Sunday PM /Sunday Overnight/
Further Information: