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Personal Assistant Application Form Submission

Title *: Miss.
First Name *:
Last Name *:
Address 1 *:
Address 2: Pontprennau
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. *: From personal experiences, I have a six year old son with mild cerebral palsy and epilepsy which has given me a greater understanding of additional needs and the actions and activities needed for extra support. In addition to this I have a 15 year old little brother who is on the autistic spectrum who I assist my mum with on outings and activities planned. Also he has a special diet due to stomach problems and I help plan and prep meals for him too.

What qualities do you think are important when working as a personal assistant with a disabled person? *: I believe showing understanding, patience and initiative to make sure they are engaged and happy.

How do you think you can contribute towards the needs and the independence of a disabled person? *: Assisting them with their freedom and decision making, while supervising and encouraging their own happy independence. Also ensuring I would also be a person that they could rely on and trust if they ever felt they needed me.

What is it about PA work which appeals to you? *: I am very caring and considerate person, that would want to help in anyway to make sure the person I was assisting lived a happy and fulfilling life.

What are your hobbies/interests?: I enjoy cooking, board games, kickboxing, gym classes and the gym.

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? *: Mon- Fri days- Thursday evening and weekend 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.: Very rare occasion if my son was unwell and if I couldnt get childcare in place in time.

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)? *:
If there is any such information you wish to provide? *: No

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- Pontprennau, Pentwyn, Llanederyn, Pontcanna, Cardiff town centre.

How many hours of work can you offer per week?: 20

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