Personal Assistant Application Form Submission


Title *: Mrs.
First Name *:
Last Name *:
Address 1 *:
Address 2:
Town *: Tonypandy
County *: Mid Glamorgan
Postcode *: CF40 
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. *: I currently work with Cwm Taff NHS as a Health Care Support Worker (level 3), working in and around the community dealing with all age groups on a daily basis. I have been driving for over 20 years and hold a clear license and hold business insurance through my weekly role.
What qualities do you think are important when working as a personal assistant with a disabled person? *: Having a 21 year old Daughter myself with High Functioning Autism, I am very well placed to understand and assist this young lady with her needs. I am an enthusiastic individual with a gentle nature and understand the need for routine. A good listener, time keeper and happy to learn and adapt where required.
How do you think you can contribute towards the needs and the independence of a disabled person? *: Firstly its about listening to this young lady, constructing a routine listing all activities, actions that is required. Together we can plan and execute a schedule in order to achieve all outputs. I am happy to adapt as I understand that change is fundamental dependant on the day, weather, mood and feelings, however Im more than happy to simply sit indoors, chat, watch soaps or play games etc
What is it about PA work which appeals to you? *: My Autistic Daughter does a lot of activity with her Dad attending a Swimming Club and she also has a PA herself where the bond between them over the years is amazing. This gives so much to her daily life skill development and I feel i could do just the same and give a little back where I have the time to give.
What are your hobbies/interests?: I like watching the soaps, completing word searches and love taking my dog Pepper for his daily walk.
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 - Thursday, PM only
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.: Nothing more to add at this moment, however Im more than happy to expand on anything further should the needs require during the interview if I am successful.

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: Nothing to report, cleared DBS through recent NHS check Mar 20 (I pay annually for use of DBS update service)
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?: 10 Mile radius from home location
How many hours of work can you offer per week?: 10
Please indicate the approximate times that you are available for work throughout the week.: Monday PM/Tuesday PM/Wednesday PM/Thursday PM/
Further Information: Nothing else to report - Thank you :-)