Personal Assistant Application Form Submission


Title *: Mrs.
First Name *:
Last Name *:
Address 1 *:
Address 2:
Town *: Barry
County *: Vale of Glamorgan
Postcode *: CF62 
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. *: VCRS Barry Hospital - Reablement Community Support Worker Mrs Alison Roberts Penarth - Live in carer Dementia Care Palliative Care Manual Handling Personal Care
What qualities do you think are important when working as a personal assistant with a disabled person? *: Sensitivity Compassion Equality Trust Calm Positivity motivation Flexibility Mindfulness Encouragement Respect Confidence Equanimity Acceptance Trust
How do you think you can contribute towards the needs and the independence of a disabled person? *: Safeguarding Assistance as and when required Space and choices Promoting Independence Encouragement Focus on Abilities Help and support with care Inclusion Availability of own choices
What is it about PA work which appeals to you? *: Giving independent care directly sometime to one person, monitoring healthy eating, administering medication to enable the individual to keep safe. Getting to know the individual over a time Supporting daily life -Independent living, personal care, household tasks, shopping, social activities, financial support. Safeguarding Rehabilitation Caring
What are your hobbies/interests?: Reading walking Socialising Family
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 - Friday
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.: Respite care

In what capacity do you know this person (should not be a family member)? *: Long Standing Friend
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?: Vale of Glamorgan
How many hours of work can you offer per week?:
Please indicate the approximate times that you are available for work throughout the week.:
Further Information: Currently working 1 week a month therefore working hours to be discussed and arranged.