O4RCT Personal Assistant Application Form Submission Title *: Miss. First Name *: Last Name *: Address 1 *: Address 2: Town *: Rhondda Cynon taff County *: United kingdom Postcode *: Phone number *: Please enter your email address for suporthbmission confirmation. *: Reference number of job being applied for *: 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 worked as a personal support worker and i get on with sevice users What qualities do you think are important when working as a personal assistant with a disabled person? *: Making sure they safe and well looked after and asking them if they want anything and talk to them How do you think you can contribute towards the needs and the independence of a disabled person? *: I can help the service user with whatever they want and be there for them What is it about PA work which appeals to you? *: I like to help people and i get on with people What are your hobbies/interests? Reading and watching tv Would you consider a casual position if you are unsuccessful with this job? *: Yes Do you drive? *: No Are you a vehicle owner? *: No Do you smoke? *: Yes Are you able to undertake training? *: Yes What days/nights are you able to work, or prefer to work? *: Any time Are there any circumstances which would prevent you from providing cover or swapping a shift? *: No If you would like to expand on the answers given above? Please use the box below.: If there is any such information you wish to provide? *: No Please provide details if necessary: I agree that there is nothing which would prevent me from doing this job. *: No 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?: Rhondda Cynon taff How many hours of work can you offer per week?: Any thing Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Monday Overnight/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/Sunday AM/Sunday PM /Sunday Overnight/Further Information: None.