Personal Assistant Application Form Submission


Title *: Mr.
First Name *:
Last Name *:
Address 1 *:
Address 2: PONTYGWAITH
Town *: FERNDALE
County *: RCT
Postcode *:
Phone number *: 07719846671
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. *: I have at least 18 years experience of working with vulnerable adults, including the Elderly and disabled. At present I am employed as a Support Worker with vulnerable adults and I have done this type of work for 8 years approx, 6 of them as middle Manager. My relevant qualifications include, NVQ 3 Health snd Socialcare, End of Life Care Level 3, Clinical Induction training for Heelthcare Support Workers and various inservice training. I used to work in the NHS as Domestic/Bank Healthcare Support Worker.
What qualities do you think are important when working as a personal assistant with a disabled person? *: Patience, understanding, empathy, hard worker and a good sence of homour. Person centered care is vital
How do you think you can contribute towards the needs and the independence of a disabled person? *: Person centered care is important and treating the client as an idividual, working with there strengths and needs
What is it about PA work which appeals to you? *: Individual care, how the service is tailored towards their needs
What are your hobbies/interests?: Playing acoustic guitar, reading, walking, cycling, keeping fit and healthy, watching tv and spending quality time with my son
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? *: Whenever apart from everyother weekend when I have my son
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.: As above, the only restriction is when I have my son

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?: 37.5
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/
Further Information: As stated I can do weekends but not when Ive got my son