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Personal Assistant Application Form Submission


Title *: Miss.
First Name *:
Last Name *:
Address 1 *:
Address 2:
Town *: Cardiff
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. *: Dip TMHA (CETSW) BA Hons (Graphics) Cert Ed 3 A levels 8 O levels


What qualities do you think are important when working as a personal assistant with a disabled person? *: Patience, understanding, dignity, affability and friendliness.


How do you think you can contribute towards the needs and the independence of a disabled person? *: I have extensive experience of working with disabled adults through work in Day Services and in the community, both as a PA and working for Social Services as well as personal experience caring for my mum and dad. This has given me an awareness of the various needs of people who have difficulties accessing facilties. I understand how important having independence is for a feeling of wellbeing.


What is it about PA work which appeals to you? *: Doing something useful in my partial retirement and giving something back for all that I have had over the years.


What are your hobbies/interests?: Art/Drawing, painting, bird watching, walking, using public transport, going to church, socialising with other people.


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? *: Daytime, evenings and weekends.


Are there any circumstances which would prevent you from providing cover or swapping a shift? *: No


If you would like to expand on the answers given above? Please use the box below.:
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? *: Yes


Please provide details if necessary:


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?: Whitchurch, Rhiwbina, Canton, Gabalfa, Birchgrove, Heath


How many hours of work can you offer per week?: 10 hr/wk


Please indicate the approximate times that you are available for work throughout the week.: Tuesday AM/Tuesday PM/


Further Information: As required in advert