Personal Assistant Application Form Submission

Title *: Mrs.

First Name *: 

Last Name *: 

Address 1 *:


Address 2:

Town *:

County *: RCT

Postcode *:

Phone number

Please enter your email address for submission confirmation. *:

Reference number of job being applied for *: DP1587

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 am a retired social worker my working career has expanded over a duration of approximately 25 years. Mainly working with children with additional needs and their families my experience has also included working with adults with learning difficulties.

What qualities do you think are important when working as a personal assistant with a disabled person? *: Listening skills is an essential quality when working with a disabled person, enabling and allowing the person to have time to express his/her needs and views, this includes verbal and non verbal communication. Supporting and encouraging the person to maintain his/her independence is also an essential quality to enable him/her to have the opportunity to make decisions in their day to day life.

How do you think you can contribute towards the needs and the independence of a disabled person? *: Engaging the person in conversation, supporting and encouraging him/her to express their likes and dislikes. Also having a conversation with their carer who may be able to support the person express his/her views and needs. Developing a relationship with the person in order that s/he feels confident to express his/her wishes.

What is it about PA work which appeals to you? *: Supporting a persons right to live as independently as possible within their own home. Building relationships with people and listening and respecting their views and needs.
What are your hobbies/interests?: walking, swimming, reading, watching TV, drawing

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 and Tuesday only

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.: commitments to my grandchildren

Name *:


Job Title *:


Phone Number *:


In what capacity do you know this person (should not be a family member)? *: Previous Team Manager

Name *:


Job Title *:

Address *:

Phone Number *:

In what capacity do you know this person (should not be a family member)? *: Friend

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?: Pontyclun, Talbot Green, Llantrisant and Llanharry
How many hours of work can you offer per week?: 10hrs
Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Tuesday AM/Tuesday PM/
Further Information: