Personal Assistant Application Form Submission

Title *: Mr.

First Name *: Last Name *: 

Address 1 *: ,

Address 2: 

Town *: Aberdare

County *: Mid Glamorgan

Postcode *: 

Phone number *: Please enter your email address for submission confirmation. *: Reference number of job being applied for *: DPC1222

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 qualified level 3 teaching assistant. currently working as a learning support assistant on a one to one basis, working daily with a child who as behaviour issues, I have a varied amount of training with certificates as proof. My experiences are drawn from the school, also my son, who was born with both a disability and behaviour issues, my son who is now grown up, as left me with a skill set I would like to share and to help a child achieve their full potential through enjoyment and care.

What qualities do you think are important when working as a personal assistant with a disabled person? *: listen , understanding, preparation, trying to walk in their shoes, to prevent rather than cure problems, to make their time one of enjoyment and inclusion
How do you think you can contribute towards the needs and the independence of a disabled person? *: Patience,understanding, planning, taking into account both the individual and family, trying to do make every meeting, one that is as enjoyable as possible. While also trying to encourage independence where possible.

What is it about PA work which appeals to you? *: The thought that I may be able to or have helped a child/ young person/adult. To enjoy an activity, an outing, a time that otherwise may not have taken place, so rewarding.

What are your hobbies/interests?: All sports both watching and participating, music, walking, reading.

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? *: Monday- Friday evenings some weekends
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.: I work full time in a school, so hours would have to be after school.

Name *: 

Job Title *: 

Address *:Phone Number *:

In what capacity do you know this person (should not be a family member)? *: Name *: Janice Price.


Job Title *: .
Address *: 

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 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?: Abercynon to Hirwaun.
How many hours of work can you offer per week?: Fifteen to Twenty per week.
Please indicate the approximate times that you are available for work throughout the week.: Monday PM/Tuesday PM/Wednesday PM/Thursday PM/Friday PM/
Further Information: I would be willing to work occasional weekends