Ffurflen Gofrestru Personal Assistants Application Form Llwytho... Please complete the form below to register your interest in joining our catalogue of Personal Assistants. Personal Details Title Mr Mrs Miss Ms Dr Father Professor Reverend First Name(s) Last Name Date of Birth National Insurance No. Address Postcode Address (Line 1) Address (Line 2) Address (Line 3) Town County Contact Details Email Retype Email Home Telephone Mobile Telephone Areas you Cover What geographic areas are you able to work? AberavonAberdulaisAllt-WenBaglanBlaengwrachBriton FerryBryn and CwmavonBrynammanBryncochCadoxtonCimlaCrynantCwmllynfellCymmerDyffrynGlyncorrwgGlynneathGodre'r GraigGwaun-Cae-GurwenGwynfiMargamNeathOnllwynPelennaPontardawePort TalbotResolvenRhosSandfieldsSeven SistersSkewenTai-bachTonnaTrebanosYstalyfera Availability When are you able to work - Please give an estimate of times that you are able to work? Monday Tuesday Wednesday Thursday Friday Saturday Sunday 7.00am - 9.30am AvailabilityMON1 AvailabilityTUE1 AvailabilityWED1 AvailabilityTHU1 AvailabilityFRI1 AvailabilitySAT1 AvailabilitySUN1 9.30am - 12.00pm AvailabilityMON2 AvailabilityTUE2 AvailabilityWED2 AvailabilityTHU2 AvailabilityFRI2 AvailabilitySAT2 AvailabilitySUN2 12.00pm - 14.30pm AvailabilityMON3 AvailabilityTUE3 AvailabilityWED3 AvailabilityTHU3 AvailabilityFRI3 AvailabilitySAT3 AvailabilitySUN3 14.30pm - 18.00pm AvailabilityMON4 AvailabilityTUE4 AvailabilityWED4 AvailabilityTHU4 AvailabilityFRI4 AvailabilitySAT4 AvailabilitySUN4 18.00pm - 22.00am AvailabilityMON5 AvailabilityTUE5 AvailabilityWED5 AvailabilityTHU5 AvailabilityFRI5 AvailabilitySAT5 AvailabilitySUN5 22.00pm - 7.00am AvailabilityMON6 AvailabilityTUE6 AvailabilityWED6 AvailabilityTHU6 AvailabilityFRI6 AvailabilitySAT6 AvailabilitySUN6 About You What gender are you? MaleFemale Are you a smoker? YesNo Do you hold a Full Driving License? YesNo Are you DBS checked? YesNo How did you hear about us? Training What qualifications do you have? Delivering Dignity and SafeguardingEmergency First AidFood Safety Level 2Induction to Dementia and Sensory ImpairmentManual HandlingPA Medication AwarenessSkin Bundle/Personal Care/ACT BriefingOther Specialisms What area of work are you interested in? Children and Young PeopleLearning DisabilityMental Health ConditionOlder PeoplePhysical Disability Personal Statement Please use this space to tell us about yourself. Please use this space to tell us about your employment history. References Referee 1 (Current / Previous Employer) Referee 1 First Name(s) Referee 1 Last Name Referee 1 Address (Line 1) Referee 1 Address (Line 2) Referee 1 Address (Line 3) Referee 1 Town Referee 1 County Referee 1 Postcode Referee 1 Email Referee 1 Telephone Referee 1 Relationship Referee 2 (Non-Employer) Referee 2 First Name(s) Referee 2 Last Name Referee 2 Address (Line 1) Referee 2 Address (Line 2) Referee 2 Address (Line 3) Referee 2 Town Referee 2 County Referee 2 Postcode Referee 2 Email Referee 2 Telephone Referee 2 Relationship Declaration I agree to the Direct Payment Support Services keeping my name, address and all the details provided below on the PA Database. The information will be held by Neath Port Talbot Council for 1 year and then deleted unless I contact Neath Port Talbot and request it is removed before this. I understand my information may be shared with people who are looking to employ a Personal Assistant in Neath Port Talbot and that people will contact me directly. Please note NPTCBC is advertising on behalf of an individual employer. You will be an employee of the Direct Payment Recipient and not of NPTCBC. I declare that the information set out in this application for is true in all respects.