Personal Assistant Application Form Submission

Title *: 

First Name *: 

Last Name *: 

Address 1 *: Address 2:

Town *: Tonypandy

County *: RCT

Postcode *: 

Phone number *:

Please enter your email address for submission confirmation. *: Reference number of job being applied for *: DP1436 DP1608

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 16 years experience working as an Occupational Therapy support worker for Cwm Taf Health Board, working in Adult Mental Health and older person’s mental health specifically dementia care

What qualities do you think are important when working as a personal assistant with a disabled person? *: I am honest, friendly, respectful and patient. I believe in thorough communication with the client and their regular care giver/family member. I like the routine of working regular hours with some flexibility when it is needed. I am able to adapt to unexpected situations.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I believe that my OT and personal experience means that I enable the client to maintain social links and access to the community. I am familiar with dealing with unplanned issues when with clients, and keeping them safe and with dignity intact.

What is it about PA work which appeals to you? *: Having two children with autism, I have given up my employment with the local health board. I hope to re-enter employment, but on a more casual basis, in order to continue to support people and enable them to lead a more fulfilling social life.
What are your hobbies/interests?: I enjoy meals in restaurants, going to the movies, historical romance novels and evenings in with my family playing board games.

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? *: Mon - Fri 09.30 - 14.30

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 care for two autistic children and occasionally have to attend medical appointments with them.

Name *: 

Job Title *: 

Address *: 

Phone Number *: 01443 443443 ext 75647

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

Job Title *: S

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?: RCT
How many hours of work can you offer per week?: Up to 10
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/Thursday PM/Friday AM/Friday PM/
Further Information: