Personal Assistant Application Form Submission 

Title *:  
First Name *: 
Last Name *:  
Address 1 *: 
Address 2: 
Town *: Porth 
County *: Mid glamorgan 
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. *: I am currently employed through Dewis and have been a PA for 10 years for a lady with MS.i also work in a care home but looking to leave and find another PA role.i have a wide range of knowledge of working with a person with a number of different disabilities.i have a qcf level 3 in health and social care and I am up to date with all of my manual handling training plus other essential training.i am looking for extra work whilst continuing to work as a PA for my current employer. 
What qualities do you think are important when working as a personal assistant with a disabled person? *: I am extremely loyal and reliable.i think the fact I have been a PA for the last 10 years proves this! I enjoy encouraging people to reach their full potential within their limits.i am very caring supportive and have a very happy and positive personality with a cheeky sense of humour! I also believe confidentiality and dignity is extremely important when working with a person with a disability 
How do you think you can contribute towards the needs and the independence of a disabled person? *: I am very patient and encouraging and believe in a person centred approach.making others happy and feel safe is my goal everyday. 
What is it about PA work which appeals to you? *: I have a 2nd job in a care home at present.i love it dearly but get frustrated that I can’t spend enough quality time with each resident due to it being such a busy my role as a PA I have enjoyed getting to know my employer and have discovering new hobbies we both enjoy together.i know all of her likes and dislikes and have adapted to recognising when she has a bad day and how to help her through it. 
What are your hobbies/interests?:I love cooking,especially for others! I enjoy being outdoors and spend all of my spare time walking and discovering hidden gems of our valleys with my dog.i also love watching films with a big tub of ice cream! 
Would you consider a casual position if you are unsuccessful with this job? *: Yes 
Do you drive? *: Yes 
Are you a vehicle owner? *: No 
Do you smoke? *: No 
Are you able to undertake training? *: Yes 
What days/nights are you able to work, or prefer to work? *: Any day of the week after 1pm 
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.:I am committed to my current role as a PA which requires me to work 8am until 1pm Monday to Friday. I have a clean full licence but have recently had to scrap my car and currently saving for a replacement 
Name *: 
In what capacity do you know this person (should not be a family member)? *: My  
In what capacity do you know this person (should not be a family member)? *: My current employer(my PA role) mother 
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?: 22 
Please indicate the approximate times that you are available for work throughout the week.: Monday PM/Tuesday PM/Wednesday PM/Thursday PM/Friday PM/ 
Further Information: Occasional weekends