Personal Assistant Application Form Submission 

Title *:  
First Name *: 
Last Name *: 
Address 1 *: 
Address 2: 
Town *: Pentre 
County *: Rhondda 
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’ve worked with partnership of care ,support mental health clients, I done care work for 12 years covering all aspects of disabilities and ages. Before I worked as a special needs teacher in England for many years . 
What qualities do you think are important when working as a personal assistant with a disabled person? *: Firstly getting to know your client Being patient Been open minded to your clients daily needs, not just want is expected, respecting your client. 
How do you think you can contribute towards the needs and the independence of a disabled person? *: By giving them encouragement and praise for each thing they accomplish Small steps Not expecting the client to be always willing and knowing they have bad days as well as good days and acknowledging their needs. ,asking things fun and interesting 
What is it about PA work which appeals to you? *: The hours Getting to know the clients and becoming a constant in their lives 
What are your hobbies/interests?: Books Films Car rides exploring the area Going for coffee 
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? *: Yes 
Are you able to undertake training? *: Yes 
What days/nights are you able to work, or prefer to work? *: Flexible 
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.: 
Name *: 
In what capacity do you know this person (should not be a family member)? *: 
Name *:
In what capacity do you know this person (should not be a family member)? *: Boss 
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?: Flexible within reason 
How many hours of work can you offer per week?: Flexible 
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: Overnights can be arranged if needed with notice and if available