Personal Assistant Application Form Submission

Title *: .

First Name *: 

Last Name *:

Address 1 *: TAddress 2: PENRHIWCEIBER ROAD


County *: RCT


Postcode *:

Phone number *:
Please enter your email address for submission confirmation. *: 

Reference number of job being applied for *: DPC1520

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. *: Education. Mountain ash comprehensive school :-September 1988-1992. Maths ,English ,science ,physical education and home economics all G.C.S.E standards. I have spent a number of years being a house wife and bringing up my children , my children are now at an age where i would like to pursue a full time career being a personal assistant. Although i have done this job part time for a number of years assisting the same individual i started this journey with. Being a personal assistant to a disabled individual helps them to live independently in their own homes and to access social environments. This may be by me assisting with ,domestic work, meal-preparation, budgeting, paper work. personal hygiene socializing or by attending different Venues and activities etc

. Throughout my career as a personal assistant i have completed training and courses in the following:- * Understanding sensory loss. * Health and safety awareness. * Safeguarding vulnerable adults. * moving and handling passport models C ,D and F. * Emergency first aid . * Peer discussions. * Epilepsy awareness. * Disability, Equality ,Diversity, Inclusion Training. * Models of disability. I have also obtained a QCF level 3 degree in health and social care and have personal experience assisting individuals who have epilepsy ,Moderate to server learning difficulties, loss of limbs, sensory loss and autistic traits. In addition to the above i also have a family member who is a leg amputee and a nephew with autism.

What qualities do you think are important when working as a personal assistant with a disabled person? *: I believe in my role as a personal assistant its important to work and support individuals and their families in a personal centred way. To always take responsibility for their safety and well being while they are in my care. To respect their right to make their own decisions and life choices also their right to privacy and confidentiality whilst working in and outside of their home. Throughout my training and experiences i have learned to promote Diversity,Equality and Inclusion to Protect individuals from


discriminatory and negative behaviour towards them. I also think its important to work in an active way to help develop life skills and access different facilities or places of enjoyment so as to promote health and well being . I will always strive to establish and maintain trust by being open, honest, reliable and punctual at all times. Being a house wife and mother has given me my nurturing and caring qualities along with my domestic abilities.

How do you think you can contribute towards the needs and the independence of a disabled person? *: Being a personal assistant i practice active participation in all areas regarding my employers. I encourage them to voice their opinions, needs and preferences which has made them grow in confidence and Independence. This has helped them within their own homes and social environments. I also have a really good working relationship with them and have assisted them for a number of years.

What is it about PA work which appeals to you? *: Having been a personal assistant for a number of years i have had the pleasure to help and support individuals to be more pro active and happier with in their own lives. To me there is nothing more satisfying than to watch a person grow in confidence and independence. To have the good fortune to play a part in this is the most rewarding and at times humbling job anyone could have.

What are your hobbies/interests?: My favourite past time is to spend quality time with my husband and children whether this is going to the cinema ,swimming, bowling or just watching t.v and relaxing together.I also like to socialize and go out with my friends on occasions. Some other hobbies and past times are bingo ,music ,shopping and cooking meals when i have the time.

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? *: my personal assistant work commitments to my other employers are :- Monday 9:30-16:00, Tuesday 9:30-13:30, Wednesday 10:00-14:00 and Friday 10:00-14:00 in addition to this i work respite once a month . I would be able to work anything before or after these hours or on a Thursday any time and some occasional Saturdays .

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.: Only when i am committed to working my other shifts.

Name *:  )
Job Title *: 

Address *: 

Phone Number *: 

In what capacity do you know this person (should not be a family member)? *:
Name *: Job Title *: my employer

Address *: 

Phone Number *: 

In what capacity do you know this person (should not be a family member)? *: She is the mother of my employer to whom i am a personal assistant.

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 *: 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?: Aberdare to Treforest or near by surrounding areas.

How many hours of work can you offer per week?: 15hrs

Please indicate the approximate times that you are available for work throughout the week.: Monday PM/Monday Overnight/Tuesday PM/Tuesday Overnight/Wednesday PM/Wednesday Overnight/Thursday AM/Thursday PM/Thursday Overnight/Friday PM/Friday Overnight/Saturday AM/
Further Information: I am a driver with my own transport with business class insurance.