Personal Assistant Application Form Submission


Title (required): Mr
First Name (required):
Last Name (required):
Address 1 (required):
Address 2:
Town (required): Bridgend
County (required):
Postcode (required):
Phone number (required):
Please enter your email address for submission confirmation. (required):
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. (required): 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. (required): Fully qualified qcf3 support worker
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Dignity confidentiality respect and to treat the individual the way i would want to be treated and understand their needs
How do you think you can contribute towards the needs and the independence of a disabled person? (required): I am currently a support worker and fully understand the needs of disabled people as i work with a variety of individuals with autism learning diffs physical and mental disabilities and challenging behaviour i think i have the necessary skills and experience to fulfil this role I’m flexible
What is it about PA work which appeals to you? (required): I’m also a pa to a gentleman who has MS i have cared for him for the past 3yrs and enjoy it immensely he is 73 yr. old man who cannot do anything for himself he is able to communicate through speech but that is all reference can be given if required
What are your hobbies/interests?: I like snooker golf cinema socialising DIY my wife and i are keen caravanners try to go away as much as we can when able to also love my garden and allotment all in all I’m i enjoy most things and i pretty flexible
Would you consider a casual position if you are unsuccessful with this job? (required): Yes
Do you drive? (required): Yes
Are you a vehicle owner?  (required): Yes
Do you smoke? (required): No
Are you able to undertake training? (required): Yes
What days/nights are you able to work, or prefer to work?  (required): Flexible
Are there any circumstances which would prevent you from providing cover or swapping a shift? (required): No
If you would like to expand on the answers given above? Please use the box below.:

Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? (required): No/
Please provide details if necessary:
I agree that there is nothing which would prevent me from doing this job. (required): Yes
I consent to the above (required): 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?: Bridgend barry port Talbot
How many hours of work can you offer per week?: Up to 20hrs more if needed
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: Pretty flexible