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Personal Assistant Application Form Submission 

Title (required): Mr. 

Town (required): Newport 
County (required): Gwent 

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): • NVQ level 3 in health and social care. • mapa trained • first aid at work • fire marshal • level 1 lifeguard • manual handling • dysphagia trained • gastrostomy care, tracheostomy care, colostomy care • food hygiene Academic qualifications School welsh medium am fully bilingual. GCSE in English - c welsh - c maths - c Training will updating. 

What qualities do you think are important when working as a personal assistant with a disabled person? (required): That the disabled person is Im charge. Im a good Good listener, have a relaxed and easy nature. I enjoy conversation but also love silence. I love to laugh and discuss lots of topics. Im a fan of nature, music, sport and generally any type of creativity. 

How do you think you can contribute towards the needs and the independence of a disabled person? (required): I can speak up when needed. And stay quiet when I need to. I can drive and have done training driving young children with complex health needs. Im conscious of the people and the environment Im In. 

What is it about PA work which appeals to you? (required): Im looking for a few hours here and there to help someone in need. The one 2 one nature of PA work has always interested in me and making new relationships 

What are your hobbies/interests?: All sports. Nature. Health and wellbeing music I play the piano. My son. 

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): Yes 

Are you able to undertake training? (required): Yes 

What days/nights are you able to work, or prefer to work?  (required): 6 hours a week days, after time can review 

Are there any circumstances which would prevent you from providing cover or swapping a shift? (required): Yes 

If you would like to expand on the answers given above? Please use the box below.: Friday and Saturday and Sunday morning I spend withy son 

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): Yes/ 

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?: Gwent,Cardiff,RCT 

How many hours of work can you offer per week?: 6-8 

Please indicate the approximate times that you are available for work throughout the week.: Tuesday AM/Tuesday PM/Wednesday AM/Thursday AM/Thursday PM/ 

Further Information: