Personal Assistant Application Form Submission 

Title *: . 
First Name *: 
Last Name *:  
Address 1 *:  
Address 2: Barry 
Town *: Barry 
County *: Vale Of Glamorgan 
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 have worked with alziemers persons as care in the community and also doing night sits.i have also worked in a nursing home but want to work with individual people. I have all certificates in care and a updated dbs I can start asap.i enjoy going for walks being out and about. helping with domestic work and helping with cooking and chatting.i have recently done my first aid course and have learnt many things in the nursing home . I read many books on alzheimers and recently cared for a lady with alziemers who went into a home .I believe in respect and dignity and confidentiality and also to get people I care for to be as independent as possible 
What qualities do you think are important when working as a personal assistant with a disabled person? *: Dignity respect understanding confidentiality and to keep the person as independent as possible 
How do you think you can contribute towards the needs and the independence of a disabled person? *: I have worked with alziemers and have learnt a lot about alziemers and how to help and keep the person as active as possible .I have never called in sick and a happy person 
What is it about PA work which appeals to you? *: You get to know the person you are a PA with and therefore you get on together and knowing you be going back to help out the next day 
What are your hobbies/interests?:Walking cooking.watching films. Seaside walks cinema 
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? *: Always available 
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 *: 
In what capacity do you know this person (should not be a family member)? *: A  
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 have a updated DBS 
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?: Barry penarth wenvoe sully dinas powys 
How many hours of work can you offer per week?: 35-48 
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 AM/Wednesday PM/Wednesday Overnight/Thursday AM/Thursday PM/Thursday Overnight/Friday AM/Friday PM/Friday Overnight/Saturday AM/Saturday PM/Saturday Overnight/Sunday AM/Sunday PM /Sunday Overnight/ 
Further Information: