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Personal Assistant Application Form Submission

Title *: Mrs.
First Name *:
Last Name *:
Address 1 *:
Address 2:
County *: Ceredigion
Postcode *:
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 significant personal experience of autism. My 15 year old son has autism. I have regularly attended a range of training and awareness sessions about ASC and established a parent support group. My professional background is working as a librarian in public library services. This was a public facing role working with different members of the community. In addition projects that had involvement with included reader development and mental health awareness and dementia awareness.
What qualities do you think are important when working as a personal assistant with a disabled person? *: I am a kind and considerate person and most importantly have a high regard for showing respect and dignity towards the person I would be working for. I have the ability to remain calm and make decisions in stressful situations. I am reliable and understand that sudden changes can be difficult for some individuals. I can communicate clearly and help to support positively if someone is anxious.
How do you think you can contribute towards the needs and the independence of a disabled person? *: I am able to support with practical functions such as budget planning. I am happy to support at social/leisure activities to enable the person to develop their independence skills. I have personal experience of helping my autistic teenage son to plan his leisure time using a diary and timetable. I recognise the importance of supporting the person to be as independent as possible in these activities.
What is it about PA work which appeals to you? *: I am interested in this work because I consider it to be important to enable individuals to have opportunities to access age appropriate activities and to be as independent as possible.
What are your hobbies/interests?: Cooking, crafts, reading, cinema, music, walking
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? *: No
Are you able to undertake training? *: Yes
What days/nights are you able to work, or prefer to work? *: My preferred time is during the day Monday to Friday but I will discuss alternative times
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.: I hope to be driving in the new year. However I can travel on public transport if acceptable to client. If the client is interested in my application I am happy to discuss work hours.
Name *:
Job Title *:
Address *:
Phone Number *:
In what capacity do you know this person (should not be a family member)? *:
Name *:
Job Title *:
Address *:
Phone Number *:
In what capacity do you know this person (should not be a family member)? *:
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?: Aberystwyth area
How many hours of work can you offer per week?: Up to 10 hours
Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Tuesday AM/Tuesday PM/Wednesday AM/Wednesday PM/Thursday AM/Friday AM/Friday PM/Saturday AM/Saturday PM/Sunday AM/Sunday PM