Personal Assistant Application Form Submission


Title *: Mrs.
First Name *:
Last Name *:
Address 1 *:
Address 2: Tonteg
Town *: Pontypridd
County *: Rhondda Cynon Taf
Postcode *: CF38 

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 am a reliable and trustworthy individual and I am a qualified Nursery Nurse. I have sound knowledge in respect of child care having worked for many years in a variety of settings. I have worked for two of the major children’s charities – Action for Children and Barnardo’s. I have a lot of experience working with children with additional needs and I promote equality and diversity in my work ethic and maintain confidentiality at all times. I am confident and able to work effectively both independently and as part of a team.
What qualities do you think are important when working as a personal assistant with a disabled person? *: I believe it is important to be kind, caring and compassionate and to be able to provide respect and dignity when dealing with personal issues. A persons strengths should be recognised and encouragement and praise provided. It is important to provide assistance however it is equally important to encourage independence that is achievable in respect of the individual. Equality and diversity is important and an individual should be empowered to be able to access activities and opportunities that are important to them. It is important to recognise the uniqueness of the individual I am working with and respond appropriately to their personal needs. I am aware of the importance of maintaining confidentiality at all times.


How do you think you can contribute towards the needs and the independence of a disabled person? *: I believe it is important to use person centred practises, promoting voice and control and ensuring an individuals needs are known and understood. I would encourage an individual to achieve their goals assisting them to do this. I would encourage an individual to maintain independence and meet their basic care needs independently as long as they are able to do so providing assistance where required. I would make myself aware of care plans that are in place to ensure I am meeting the all round needs of an individual. I would make myself aware of risk assessments to minimise problems. I am at the same time aware of the benefits of positive risk taking. It is important to ensure an individual is able to access opportunities both socially and educationally.


What is it about PA work which appeals to you? *: I enjoy being able to help and support people to achieve what is important to them. It gives me a sense of fulfilment when I am able to make a difference to a persons life that helps them to feel good about themselves.


What are your hobbies/interests?: I do a lot of walking. I like swimming. I like to go to the cinema. I like nature and the outdoors.


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? *: Any hours would be considered
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.:

Rehabilitation of Offenders Act 1975 * Within the nature of the work for which you are applying this position is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1975 (Exemptions Order). Applicants are therefore not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of this Act. In the event of employment, any failure to disclose such convictions could result in dismissal. Information given is confidential and will only be considered for the purposes of the application.

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?: Rhondda Cynon Taf
How many hours of work can you offer per week?: Approximately 20
Please indicate the approximate times that you are available for work throughout the week.:
Further Information: