Personal Assistant Application Form Submission

Title *: .

First Name *:
Last Name *:
Address 1 *:
Address 2:

Town *:
County *:
Postcode *:

Phone number
Please enter your email address for submission confirmation. *:
Reference number of job being applied for *: DP173

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. *: March 2018 – November 2019 – BooCare – Somerton – Home Care Worker - Providing a good standard of care to individuals in their own homes. November 2015 –November 2016 Aster Living, Wells – Support Worker (Learning Disabilities). Supporting individuals within their own homes helping with daily living skills, personal care, travel escort, teaching independent life skills and accessing community based social and leisure activities. Administration/accurate record keeping. July 2013 – October 2015 Southlawns Care Home, Street – Relief Care Assistant - Delivering the best standard of care and support. Key duties include personal care, washing and bathing, assisting with mobility, light domestic duties and social activities. Accurate Record Keeping. Health & Social Care, BTEC Level 3 Extended Diploma Awarded - Triple Distinction * - July 2014.

What qualities do you think are important when working as a personal assistant with a disabled person? *: Honest, reliable, respectful and dependable. Friendly, supportive and approachable. Good listener, polite, tolerant, understanding and caring

How do you think you can contribute towards the needs and the independence of a disabled person? *: I have a lot of experience in care and support work, particularly with disabled individuals. I listen to what their wishes are and respect this. I am fully aware that they have a right to choice and will respect this at all times (unless it is something that puts them or someone else in danger). I will always try and encourage the individual to do things by themselves to promote their independence, but where needed will give a helping hand.
What is it about PA work which appeals to you? *: I have always been very passionate about working in the care / support industry, it find it very rewarding knowing I can make a difference to someone’s life. I have good social skills and enjoy making the most of these.
What are your hobbies/interests?: Going for walks. Exercising. Listening to music. Watching films.

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? *: Yes

Are you able to undertake training? *: Yes

What days/nights are you able to work, or prefer to work? *: Monday - Friday afternoon / evening preferable (all hours). Some weekends and Friday evenings.

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.: Some weekends I go back to Somerset where I used to live to visit family. I am very flexible in the week, however, and will be available to swap weekend hours sometimes. I will be more than happy to pick up extra shifts where I can.
Name *:

Job Title *:
Phone Number *:
In what capacity do you know this person (should not be a family member)? *:
Job Title *:
Address *:
Phone Number *:
In what capacity do you know this person (should not be a family member)? *:
Is there is any such information you wish to disclose relating to any convictions? *: 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 *: Ye

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 Taff

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/Monday Overnight/Tuesday AM/Tuesday PM/Tuesday Overnight/Wednesday AM/Wednesday PM/Wednesday Overnight/Thursday AM/Thursday PM/Thursday Overnight/Friday AM/
Further Information: I will be available some weekends but can work most hours required throughout the week.