Personal Assistant Application Form Submission Title (required): Mr. 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): GCSE`s, Electrical Engineering, Diploma in Theology. Teacher, Musician, Electrician, Teaching Assistant for Autistic Children, Customer Service in Retail. Work with autistic children required patience, compassion, dependability and keeping calm in difficult situations. What qualities do you think are important when working as a personal assistant with a disabled person? (required): Patience, dependability, being attentive and empathetic to peoples needs compassion, respectful to the person and their home, ability to use initiative knowledge of the persons disability, sense of humour and good communication skills. How do you think you can contribute towards the needs and the independence of a disabled person? (required): I can help them maintain their independence by working alongside their chosen routine and encouraging their self esteem. I can bring a happy presence and cheerful disposition into each day. What is it about PA work which appeals to you? (required): Contributing to uphold the independence and quality of a persons life. Over a period of time building a rapport and relationship with that person. What are your hobbies/interests?: Music, Chess, Bowls, Fishing, Church, Gardens, Dogs, Walking, Cooking and Portugal. Would you consider a casual position if you are unsuccessful with this job? (required): Yes Do you speak any other languages? (required): Portuguese (learning). 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): No sleep overs.. All other times I am available . 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.: I own a Smartcar which two seats and unsuitable for a wheelchair. I have an understanding of Diabetes and Asthma. Do you have portable DBS (which has been paid for and renewed for the current year)? (required): No/ 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?: Within a five mile radius of my home. How many hours of work can you offer per week? (required): 15 hours. Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Tuesday AM/Tuesday PM/Wednesday AM/Wednesday PM/Thursday AM/Thursday PM/Friday AM/Friday PM/Saturday AM/Saturday PM/Sunday AM/Sunday PM / Further Information: