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Title *: Miss.

First Name *:

Last Name *:

Address 1 *:

Address 2: Pentrebane

Town *: Cardiff

County *: Caerdydd

Postcode *:

Phone number *:

Please enter your email address for submission confirmation. *:

Reference number of job being applied for *:

Give details of your previous employment or experience which you think would help you to do this job. *: Health and Social Care BSc (Hons), 1 year nursing qualified.

What qualities do you think are important when working as a personal assistant with a disabled person? *: To be patient, kind, calm, compassionate, caring and have a good sense of humour.

How do you think you can contribute towards the needs and the independence of a disabled person? *: By helping the person maintain their independence whilst giving as much support as needed. Encouraging the person to complete tasks. I can help with cooking, cleaning, going out in the community such as attending groups, appointments and socialising.

What is it about PA work which appeals to you? *: I have been a PA for the past 7 years and love doing my job.

What are your hobbies/interests?: I love spending quality time with family and friends. I enjoy watching the rugby, soaps and medical dramas. I like listening to all kinds of music. I also Ike to go walking and shopping.

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? *: Monday, Tuesday (day and\or nights) Friday after 11am.

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)? *:

My employer 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?: 40

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 Overnight/Friday PM/Saturday Overnight/Sunday Overnight/

Further Information: I am currently working on some of the days I have not ticked or have family commitments.