236RCT Personal Assistant Application Form Submission Title *: Mrs.First Name *: Last Name *: Address 1 *:Address 2: BeddauTown *: PontypriddCounty *: Rhondda Cynon TaffPostcode *: CF38 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. *: YesPlease 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 am a trustworthy female individual who has recent and past experience with individuals who have recovered from various strokes. I am loving and compassionate about all aspects of my job role which has led me to become the individual I am today. I have personal experience of caring for a family member with heart and liver conditions. I am fully flexible and have my own transport to carry out duties which are required. What qualities do you think are important when working as a personal assistant with a disabled person? *: - Loving and caring - Compassion - Trustworthy - Flexible - Reliable How do you think you can contribute towards the needs and the independence of a disabled person? *: I currently work with disabled adults who have various conditions in a residential home, I can apply the skills and knowledge I have to full-fill this post. What is it about PA work which appeals to you? *: Caring for others who need support. What are your hobbies/interests?: I have grandchildren who I love spending time with especially outdoors. Would you consider a casual position if you are unsuccessful with this job? *: YesDo you drive? *: YesAre you a vehicle owner? *: YesDo you smoke? *: YesAre you able to undertake training? *: YesWhat days/nights are you able to work, or prefer to work? *: Monday-Saturday mornings/ afternoonsAre there any circumstances which would prevent you from providing cover or swapping a shift? *: NoIf 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? *: No/Please provide details if necessary: I agree that there is nothing which would prevent me from doing this job. *: YesI consent to the above *: YesI agree that the information I provide will be posted to the Dewis CIL PA noticeboard (all personal information will be withheld).: YesWhat geographical area’s are you able to cover?: Pontypridd How many hours of work can you offer per week?: 16 plus 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/Further Information: