Personal Assistant Application Form Submission

Title *: Mrs.
First Name *:
Last Name *:
Address 1 *:
Address 2: Gilfach Goch
Town *: Porth
County *: Rhondda
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. *: The experience I am able to being to this is from helping and supporting my grandparents through illness. My grandmother lived with me after a period of time in hospital following accidents which left her unable to look after herself safely at home. This included personal care. My grandfather had dementia and Parkinson’s so whilst my grandmother was in hospital I looked after him on a daily basis. I have provided support to an elderly lady and gentleman in their homes. This included domestic work, assisting them with taking medication and also personal care. I felt that they benefitted from not only my support but from having company and someone to talk to and I loved hearing about their life experiences. I have also been lucky enough to be able to provide respite care during the school holidays for a young boy with autism. He would live alongside my family and loved being able to join in with the activities that we were doing. I thoroughly enjoyed this experience and would love to have the opportunity to be able to provide the same care to another family. I still keep in touch with Lucas and his family. I have raised a family of 7 children whose ages currently range from 10 - 33 years old. This alone has brought its own challenges, responding to their own personalities and diverse interests. I always made sure that there was lots of fun and variety in responding to their individual needs along with providing emotional support.
What qualities do you think are important when working as a personal assistant with a disabled person? *: An ability to understand the individual’s personal and emotional needs and being able to provide support in a caring, safe and fun way and being able to adapt to different situations if they arise
How do you think you can contribute towards the needs and the independence of a disabled person? *: By supporting them to be able to do things for themselves and always encouraging them to learn new skills. Having the ability to listen, observe and guide them in their day to day life.
What is it about PA work which appeals to you? *: Being able to help people and give support when and where needed.
What are your hobbies/interests?: I enjoy being outdoors, love camping, all sports. Love listening to music and being creative.
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 to Friday
Are there any circumstances which would prevent you from providing cover or swapping a shift? *: No
If you would like to expand on the answers given above? Please use the box below.:

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?: Rhondda Valleys
How many hours of work can you offer per week?: 25 hours per week
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: