Personal Assistant Application Form Submission

Title *: .

First Name *:Last Name *: 

Address 1 *: 

Address 2: 

Town *: Cardiff

County *: Wales

Postcode *: 

Phone number *: 

Please enter your email address for submission confirmation. *: JReference 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 habe working in the Community with lynton community care and quarry hall care home also iss community care and willowbrooke nurseing home whikr working with lynton i started my qcf level 2 iv had training with all the in the jobs manual handling safe garding medicine awareness first aid skin and care
What qualities do you think are important when working as a personal assistant with a disabled person? *: To be friendly and approachable, reliable, understanding and have patience,

How do you think you can contribute towards the needs and the independence of a disabled person? *: I would use the skills i have gained as a care assistant and as a mother to help the person live as independently as possible by teaching them life skills for example how to clean cook manage appointments and help them to understand how to use public transport correctly

What is it about PA work which appeals to you? *: I have worked as part of a team in the community and in a care home setting i love to help people as much as possible i worked on a one to one bases with a older gentleman with Alzheimers cancer and many other problems i enjoyed my 5hours twice aweek with him as i new i could give him as much independent as he needed
What are your hobbies/interests?: Reading, swimming, bakeing Spending time with my family

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? *: Yes

Are you able to undertake training? *: Yes

What days/nights are you able to work, or prefer to work? *: Monday 10am to 6pm wesnesday 10am till 6pm friday 10am till 6pm sunday eveining 4pm till 8pm

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.: My daughter has chronic lung disease when shes unwell that may prevent me from cover or swapping but family help out as much as possible when shes taken into hospital so it doesnt effects work life

Name *: 

Job Title *:

Address *: Phone Number *:

In what capacity do you know this person (should not be a family member)? *: 

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?: Llanrumney rumney st mellons trowbridge

How many hours of work can you offer per week?: 24-36

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

Further Information: I may take more hours and over night work if i can