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Personal Assistant Application Form Submission


Title *: Miss.
First Name *:
Last Name *:
Address 1 *:
Address 2:
Town *: Cyncoed
County *: Cardiff
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. *: Level 5 in health and social care Level 4 diploma in counselling ASSIST trained Health and safety, fire warden and first aid trained 10 GCSES Grades A* to C


What qualities do you think are important when working as a personal assistant with a disabled person? *: Inclusivity, being able to treat someone as an equal, patience, empathy, listening skills, being friendly and loyal.


How do you think you can contribute towards the needs and the independence of a disabled person? *: Im outgoing so am wanting to help people get back into the community as I feel its important that people are able to improve their happiness


What is it about PA work which appeals to you? *: Variety and the ability to help


What are your hobbies/interests?: Reading, comedy, live music, pub quizzes, socialising, learning and generally enjoying things.


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? *: Yes


Are you able to undertake training? *: Yes


What days/nights are you able to work, or prefer to work? *: Wednesday evenings, Saturday mornings and or Sunday afternoon to evening


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.: I work full time Monday to Friday


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


How many hours of work can you offer per week?: 8


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

Overnight/Sunday AM/Sunday PM /Sunday Overnight/