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Personal Assistant Application Form Submission


Title *: Mr.
First Name *:
Last Name *:
Address 1 *:
Address 2:
Town *: ABERDARE
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 currently work as a Healthcare Support Worker to undertake identified tasks in relation to the care environment and in relation to the direct care of patients. I help to perform and record observations such as blood pressure, pulse, temperature, respirations, oxygen saturations and blood glucose monitoring. I help to identify any perceived changes noted in a patient’s condition to the senior nurse on duty. I undertake care of superficial wound dressings. I assist the nursing and medical team in procedures carried out on the unit. I work within the policies and procedures as laid down within the University Health Board and observe the safety of patients and visitors. I help do everything possible to ensure the comfort and consideration of the patient and his/her family or friends, and to relate with kindness and sympathy to all concerned. I maintain confidentiality of information regarding patients at all times. I maintain the dignity and privacy of patients at all times. I previously worked as a care assistant for a care agency primarily in a home for children with autism and behaviour that challenges. My role included supporting the young persons in their home and school settings and encouraging them with their school work and life skills. I worked as a senior care assistant in a nursing home which was the home to older adults with dementia and behaviour that challenges. My role included supporting and directing a team of staff to provide the best and kindest care possible by maintaining the residents dignity and respect whilst helping with their physical and emotional needs as per their individual care plan. The role also involved monitoring the residents and recording relevant information in their daily records. I also helped to create and prepare the daily / monthly paperwork, ensured care plans are in place, maintained and adhered to. I undertook the task of creating the weekly rota of over 30 staff to help the newly appointed manager and unit leaders. I worked as a support worker for vulnerable adults. My role included supporting individuals in accordance to service plans, recording any relevant information accurately in a service diary, administering medication and complying with all relevant rules and regulations (Health & Safety, Data Protection, Manual Handling). As this role required personal care, it was paramount that I was able to gain the individuals trust and respect whilst maintaining their dignity. I exercised fantastic time keeping skills as I had a limited time per call.


What qualities do you think are important when working as a personal assistant with a disabled person? *: It is important to be patient with the person and be empathetic and compassionate at all times. It is vital to enable the person to be as independent with as much as is possible for them, and to never take over and disable them. You must respect the dignity of the person at all times.


How do you think you can contribute towards the needs and the independence of a disabled person? *: I have a vast history of working with people with numerous disabilities and have always worked with the person to identify and accomplish alternative ways to carry out tasks as independently as possible.


What is it about PA work which appeals to you? *: I have always enjoyed working with people and helping people live fulfilling and independent lives. I enjoy building relationships and rapport with people and having the opportunity to have a positive impact on a persons life and encouraging them to maintain independence and social mobility, and therefore benefit their well-being would give me great satisfaction.


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? *: Preferably weekdays, after school and occasional weekends.


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 currently work full time so would be unable to work, cover for or swap to those days. I am however flexible around my full time commitments.


Name *:
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)? *:
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 posted 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 Merthyr Tydfil


How many hours of work can you offer per week?: 10 – 12


Please indicate the approximate times that you are available for work throughout the week.: Monday PM/Monday Overnight/Tuesday PM/Tuesday Overnight/Wednesday PM/Wednesday Overnight/Thursday PM/Thursday Overnight/Friday PM/Friday Overnight/Saturday AM/Saturday PM/Saturday Overnight/Sunday AM/Sunday PM /Sunday Overnight/
Further Information: