Personal Assistant Application Form Submission


Title *:
First Name *:
Address 1 *:
Address 2:
Town *: Pontypridd
County *: RCT
Postcode *:
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. *: QCF level 3 in health and social care CACHE level 3 Epilepsy training First aid training Manual handling training Medication training Team TEACH training PBM training
What qualities do you think are important when working as a personal assistant with a disabled person? *: Patience, understanding, loving and kind, open minded, punctuality, flexibility
How do you think you can contribute towards the needs and the independence of a disabled person? *: I have always worked in this field. I currently work at a respite house in Rhydyfelin for children with disability’s and I absolutely love going to work. I work as a senior practitioner so I am responsible for leading shifts and completing the children’s paperwork and plans. I feel that all of the skills I use day to day at work would fit in perfectly to the role of a PA.
What is it about PA work which appeals to you? *: I like the idea of using my spare time to help others, I’m currently working shifts but looking to do something alongside this. I feel that working as a PA is something that I would really enjoy and hopefully be able to build great working relationships with the person requiring assistance.
What are your hobbies/interests?: I often take my grandparents out into the community and also enjoy shopping and going out for coffee with friends.
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? *: Currently working varied shifts with 2/3 days off a week.
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.:
Name *:  
Job Title *:
Address *:  
Phone Number *:
In what capacity do you know this person (should not be a family member)? *:
Name *:
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 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?: Around 10 hours
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/Friday PM/Friday Overnight/Saturday AM/Saturday PM/Saturday Overnight/Sunday AM/Sunday PM /Sunday Overnight/
Further Information: