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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/