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Personal Assistant Application Form Submission


Title *: Mrs.
First Name *:
Last Name *:
Address 1 *:
Address 2: Llanedeyrn
Town *: Cardiff
County *: South Glamorgan
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 have worked in care for the past 5 years, I am currently providing care to somebody who has cerebral palsy and enjoy the job.


What qualities do you think are important when working as a personal assistant with a disabled person? *: Having a positive and caring nature also a good listener who has a good sense of humour. An ability to be flexible when needed


How do you think you can contribute towards the needs and the independence of a disabled person? *: By patient, kind and caring


What is it about PA work which appeals to you? *: I like caring for people and having the feeling that I have made a difference to there day


What are your hobbies/interests?: Reading, listening to music, shopping, Talking and meeting new people


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? *: No


Are you able to undertake training? *: Yes


What days/nights are you able to work, or prefer to work? *:


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.: I am currently employed which makes me unavailable Tuesday evenings and early Wednesday mornings also Saturday evenings and early Sunday mornings


Name *:
Job Title *:
Address *:
Phone Number *:
In what capacity do you know this person (should not be a family member)? *:

Name *:
Job Title *:
Address *:
Phone Number *:
In what capacity do you know this person (should not be a family member)? *:


If there is any such information you wish to provide? *: Yes


Please provide details if necessary: Would rather disclose in person


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?: Cardiff


How many hours of work can you offer per week?: To be discussed


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