Personal Assistant Application Form Submission


Title *: Miss.
First Name *:
Last Name *:
Address 1 *:
Address 2: Llanharry
Town *: Llanharry
County *: RCT
Postcode *: cf72 
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 around 7 years. I have worked as a domicilliary carer, and have experience with working with service users with a variety of health conditions and care needs. I am also All Wales Moving and Handling passport trained, first aid trained and have both my level 3 and level 5 QCF in Health and Social care.
What qualities do you think are important when working as a personal assistant with a disabled person? *: I am patient and caring. I enjoy having a laugh with my service users, as I think its important to get on with people and have a giggle whilst still doing the job at hand.
How do you think you can contribute towards the needs and the independence of a disabled person? *: I would always encourage any service users I work with to remain as independent as possible whilst still providing the help and care they needed. I will also put the service users needs and wishes first.
What is it about PA work which appeals to you? *: Being able to build a close relationship with my service users. In dom care this is hard as you visit so many different people on a day to day basis. It would also be nice being close to home, as I have a young daughter.
What are your hobbies/interests?: I enjoy spending time with my family, especially my daughter who almost one and my nephew who is three. I have a dog, and we enjoy going on adventure walks with her, whilst looking for bugs and wildlife and anything else we can find on our adventures. I also enjoy reading, watching documentaries and relaxing in the garden.
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? *: Fully flexible if given notice (a week would be ample notice to change shift patterns).
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.:

Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? *: 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?: Llanharry area but able to drive - so willing to work around this area. (eg - Cowbridge/Pontyclun/Llanharran etc) Would travel further if hours were longer sits or overnights.
How many hours of work can you offer per week?:
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: