Personal Assistant Application Form Submission

Title *: Miss.
First Name *: 
Last Name *: 
Address 1 *: 
Address 2:
Town *: Tonypandy
County *: Mid Glamorgan
Postcode *: CF40
Phone number *: 
Please enter your email address for submission 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 have worked alongside adults with learning disabilities for the last 4 years, covering all ranges of difficulties. I have worked in sessional calls, family homes and supported living homes. I have been on course that have given me strong knowledge and gained qualifications. I have the following certificates in: Manual handling Epilepsy and Buccal Midazolam Emergency first aid Bipolar Social care Posture management Medication administration Dementia Catheter Care Storms Care Mental Health awareness Safeguarding Diabetes awareness I consider myself as a confident person, with the ability to support individuals in the best ways for an independent life most suitable for them.

What qualities do you think are important when working as a personal assistant with a disabled person? *: To have a friendly approach at all times, to be appropriate at all times. It is very important to have a good bond with the individuals you work with, a strong trustworthy bond with plenty of patients. Be able to problem solve and to have excellent communication skills.

How do you think you can contribute towards the needs and the independence of a disabled person? *: Since undertaking plenty of courses I have gained good knowledge in different needs. I am always happy to support someone in social activities which individuals enjoy. With plenty of encouragement I believe we can set and meet new goals.

What is it about PA work which appeals to you? *: Becoming a PA would be a great opportunity and knowing you are making a difference to someone’s life is so important to me. Being able to support different people in different needs to enjoy different activities of their own choice.

What are your hobbies/interests?: I like spending quality time with friends and family, I enjoy walking my dog, and playing bingo. I also like reading magazines and watching TV.

Would you consider a casual position if you are unsuccessful with this job? *: No
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? *: Monday - Friday 7am - 4pm, Saturday and Sunday day time. I am able to work night shifts but prefer day time work.
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. *: 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?: All
How many hours of work can you offer per week?: 30
Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Tuesday AM/Tuesday PM/Tuesday Overnight/Wednesday AM/Wednesday PM/Wednesday Overnight/Thursday AM/Thursday PM/Friday AM/Saturday AM/Sunday AM/Sunday PM /

Further Information: