Personal Assistant Application Form Submission


Title *: 
First Name *: .
Last Name *: .
Address 1 *: 
Address 2: 
Town *: Treorchy
County *: RCT
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. *: I currently work in Llwynapia Learning Curve with adults with learning disabilities. I have worked for this service for 16 years.
What qualities do you think are important when working as a personal assistant with a disabled person? *: I think an understanding of the person and getting to know them. Patience, confidentiality, giving choices, easy to talk.
How do you think you can contribute towards the needs and the independence of a disabled person? *: By taking them out into the community, giving choices, advising them on things, good listener, easy to talk to.
What is it about PA work which appeals to you? *: Working on a one to one basis helping the person to live as normal life as possible.
What are your hobbies/interests?: Socialising, chatting, walking, cooking and willing to try new 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? *: No
Are you able to undertake training? *: Yes
What days/nights are you able to work, or prefer to work? *: Evenings, monday to thursday
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)? *: 
Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? *: No/
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?:
How many hours of work can you offer per week?: 8 hours
Please indicate the approximate times that you are available for work throughout the week.: Monday PM/Tuesday PM/Wednesday PM/Thursday PM/
Further Information: