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Personal Assistant Application Form Submission


Title *: Ms.
First Name *:
Last Name *:
Address 1 *:
Address 2: Barry
Town *: Rhoose
County *: Vale of Glamorgan
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. *: I have been a hairdresser for 23 years. In the last 6 years I have worked in a care home environment and also in the community. I have gained the experience and confidence required to become a one on one PA. I am a driver and live in Barry.


What qualities do you think are important when working as a personal assistant with a disabled person? *: Caring, patient and understanding of your Indpendance. Reliable and a fun person to be around. Respectful of your privacy. Compassionate, a good listener. I have a positive attitude.


How do you think you can contribute towards the needs and the independence of a disabled person? *: By encouraging independence, and providing opportunities for a better quality of life. Help you improve your overall health.


What is it about PA work which appeals to you? *: The fact that it is a one on one position, enabling me to give all of my time and attention that the service user requires. Substaning contiunity.


What are your hobbies/interests?: I love to read, Martina Cole being one of my fav. Photography, I love yo capture sunsets & sunrises. Music the 80s, cooking, I love a Sunday roast and loads of other things, Im a real foody. Concerts, musicals, going to the cinema. Walking, shopping, buying a new bottle of purfume as a treat to myself, Coffee shops.


Would you consider a casual position if you are unsuccessful with this job? *: No
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? *: Both days, the Tuesday and the Saturday.


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)? *:


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 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


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?: The Vale of Glamorgan


How many hours of work can you offer per week?: 40 hours


Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Monday Overnight/Tuesday 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: I would be able to cover holidays and sick days for other PAs