Personal Assistant Application Form Submission 

Title *: Mrs. 
First Name *: Nicola 
Last Name *: Robinson 
Address 1 *: 
Address 2:  
Town *: Trealaw 
County *: Rhondda Cynon Taff 
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. *: For over 15 years I have worked as a health care support worker.My role has taken place in various settings such as community based houses and hospital environments. I have supported many different individuals with all aspects of daily living , but the main focus of my job has always been to promote equality and independance while supporting the individual to meet their personal goals . Some of the duties involved has ranged from offering assistance with personal care to accompanying individuals on a community visit . I have completed basic first aid training along with moving and handling and all other mandatory training . I also have knowledge of epilepsy and would be comfortable if support was required around this.As part of my role I am always aware of safeguarding adults and confidentiality and would be confident to manage different situations if they were to arise . 
What qualities do you think are important when working as a personal assistant with a disabled person? *: There are many qualities that I think could be desirable , some which are important to myself are To be trust worthy To be calm and patient To have a good sense of humour To be reliable To be flexible 
How do you think you can contribute towards the needs and the independence of a disabled person? *: I feel that I have a varied work and life experience ,there fore i have lots of different skills within the health care role , and I am a very passionate person about my work and support I offer .I will always give 100% to ensure that indibiduals needs are met and that they are enabled and happy as far as practically possible, at the same time following a proffesional manner. 
What is it about PA work which appeals to you? *: I have always achieved job satisfaction, Through seeing individuals achieve and maintain their goals and thoroughly enjoy the healthcare support worker role . 
What are your hobbies/interests?: Some of my hobbies are walking, spending time with family indoors and outdoors. I am also quite a crafty person who will have a go at most things , and if there is time the occasional book or box set. 
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? *: Flexible , and can work with mutual agreements made to suit 
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.: Notice will be needed due to family and other work commitments 
Name *: 
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?: Rhondda 
How many hours of work can you offer per week?: 8 -10 
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: Will need to pre arrange working days / times as this could change but will be able to commit to 4 weeks at a time then new availability to suit .