Personal Assistant Application Form Submission

Title *: Mrs.

First Name *: 

Last Name *: 

Address 1 *: 9

Address 2: Owners Avenue

Town *:
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. *: Educated to O level QC F level 3 I have worked in the care sector for 10 .years.I worked as a Personal assistant for 6years caring for two terminally ill young adults. My role required me to carry out all aspects of Personal care, Administering and ordering medication, completing daily records, liasing with other professionals e.g. Dr, District nurses, Physiotherapists and escorting the individuals to access the community. I currently work as a Support worker .Supporting individuals to live independently. I have also worked as a Health care assistant in a nursing home.

What qualities do you think are important when working as a personal assistant with a disabled person? *: I think to work as a Personal Assistant you need to be patient, considerate,helpful and caring.Always considering the persons needs for privacy and confidentiality.Always treating others how you would wish to be treated.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I think I could contribute by helping and assisting them to live a full and eventful life by promoting their independence.Encouraging and supporting them to achieve different things and enjoy life to the full

What is it about PA work which appeals to you? *: PA work appeals to me because you


are able to get to know the likes and dislikes of the person on a more personal level. You are able to work alongside them to achieve what they want

What are your hobbies/interests?: I enjoy reading,socialising, meeting new people, my grandchildren and going on holidays


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? *: Yes

Are you able to undertake training? *: Yes

What days/nights are you able to work, or prefer to work? *: I am able to work Days and nights Monday to Friday. I would prefer Saturday all day till 6pm and Sunday after 12pm, I would be prepared to work if needed.

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.:

Job Title
Address *:

Phone Number *:

In what capacity do you know this person (should not be a family member)? *:
Name *:

Job Title *:
Address *:
Phone Number *:

In what capacity do you know this person (should not be a family member)? *: Aquaintance

If there is any such information you wish to provide? *: 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 post

ed to the Dewis CIL PA noticeboard (all personal information will be withheld).: Yes

What geographical area’s are you able to cover?: Rhondda cynon taff

How many hours of work can you offer per week?: 30

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/Sunday PM /Sunday Overnight/
Further Information: