Personal Assistant Application Form Submission


Title *: Mrs.
First Name *:  
Last Name *: 
Address 1 *: 
Address 2: 
Town *: Aberdare
County *: Rhondda Cynon Taff
Postcode *: CF44 
Phone number *: 
Please enter your email address for submission confirmation. *: 


Reference number of job being applied for *: 


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 have worked as a Personal Assistant for 2 years. I currently work with a lady with cerebral palsy, and a gentleman who has a brain injury. Through these positions I have experience of working both within the home and in the community. I assist with planning activities and exploring new interests in the community, and help with getting to these activities and supporting these individuals when there. I also assist with personal care needs, and supervising with medication. Prior to this I was an Occupational Therapist for 17 years working in a community rehabilitation setting. I have had experience of working with individuals who have a diagnosis of Autism, but I realise that each individual is different.


What qualities do you think are important when working as a personal assistant with a disabled person? *: I feel that flexibility, reliability, honesty are essential. I feel strongly that everyone has the right to reach their full potential, but this needs to be done sensitively and with empathy without setting individuals up to fail. I am also full aware of the need to respect client confidentiality.


How do you think you can contribute towards the needs and the independence of a disabled person? *: I am a motivated person, and I feel that I can help others achieve their goals. I am also realistic, and am able to listen and encourage. I am adaptable, and able to work in the home and the community whilst being aware of any risks and reducing these to the best of my ability.


What is it about PA work which appeals to you? *: As I have worked as a PA for 2 years I enjoy the continuity of working with the same individuals and watching them achieve some of their goals. I also enjoy helping them to be independent in the community.


What are your hobbies/interests?: I have 2 sheep dogs which I enjoy walking. I have horses which I ride and compete, and a small flock of sheep.


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? *: Tuesday evening, Wednesday daytime, Thursday daytime or evening, Friday daytime
Are there any circumstances which would prevent you from providing cover or swapping a shift? *: No
If you would like to expand on the answers given above? Please use the box below.:


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?: Aberdare, Aberaman, Hirwaun, Penderyn
How many hours of work can you offer per week?: 12
Please indicate the approximate times that you are available for work throughout the week.: Wednesday AM/Thursday AM/Thursday PM/Friday AM/


Further Information: