311RCT Personal Assistant Application Form Submission Title (required): Mrs.First Name (required): Last Name (required): Address 1 (required): Address 2: Town (required): Pontypridd County (required): Mid Glamorgan Postcode (required): Phone number (required): Please enter your email address for submission confirmation. (required): Reference number of job being applied for (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): 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. (required): My previous experiences of personal assistants/ caring are - I helped an elderly lady. I cleaned her home once a week , did light lunches, shopping ,ran errands. I was a Companion And gave her emotional support. This was 2002-2004. I cared for my daughter who had ME during her teenage years. There were times that I would do everything for her, including emotional support, personal hygiene, shopping and attend appointments With her. This was approx 2007-2012. I was a full time carer for my husband who suffered from severe depression and anxiety. During the last 15 years or so , after experiencing a slipped disk , his back got progressively worse. He had an operation, after which he was still in severe pain. I did whatever was needed during these years . Personal hygiene,medication,arranged and Attended appointments with him. Emotional support. Tried to encourage him to go out with me. This was approximately from 1997-2019 . What qualities do you think are important when working as a personal assistant with a disabled person? (required): The qualities I feel a personal assistant needs are patience, empathy, flexibility, a good time keeper, encourager , willing to adapt , honest, hard working, trustworthy, a good listener, can keep a confidence, respectful of the persons privacy . How do you think you can contribute towards the needs and the independence of a disabled person? (required): I have patience and Commpasion for people. I would encourage, be willing to learn in order to help the person more . What is it about PA work which appeals to you? (required): I like helping/ befriending people. I like to encourage and support. What are your hobbies/interests?: I love walking especially in the countryside or beaches. I enjoy learning new skills . I am learning quilting. making items with air dry clay , reading . Playing games eg / draughts, scrabble etc . Watching true stories on film . Love to take photos on my phone . Crafts . I enjoy company , spending time with my family , friends and my dog! Would you consider a casual position if you are unsuccessful with this job? (required): YesDo you drive? (required): NoAre you a vehicle owner? (required): NoDo you smoke? (required): NoAre you able to undertake training? (required): YesWhat days/nights are you able to work, or prefer to work? (required): I am able to work 20-25 hours a week. I would prefer 5-6 hourly shifts rather than 1-2 hours . Tuesday-Saturday Days or nights . If nights i would prefer them together . Would also prefer the same shifts / days / nights each week if possible but can be flexible. Are there any circumstances which would prevent you from providing cover or swapping a shift? (required): YesIf you would like to expand on the answers given above? Please use the box below.: Sickness. If other important plans/appointments have been in place Previously that can’t be changed . 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): YesI consent to the above (required): 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?: Beddau Villages / areas within a bus journey from Beddau ( I don’t drive) How many hours of work can you offer per week?: 20-25Please indicate the approximate times that you are available for work throughout the week.: 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/Further Information: I would be happy to do two On call nights ( work part , on call part) so long as I am paid all night . I would prefer them together rather than spread out .