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Personal Assistant Application Form Submission

Title *: Mrs.
First Name *:
Last Name *:
Address 1 *:
Address 2
Town *:
County *: Cardiff
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. *: O Levels, Certificate in Welfare Studies, BA Diploma in Social Work. PQ1 - 5 (incorporating the Community Care Award). I am a retired Social Worker having had a career supporting people with dementia to live safely at home. I have also been a live in carer having previously supported two older ladies with dementia to continue to live independently in their own homes.

What qualities do you think are important when working as a personal assistant with a disabled person? *: I am friendly and personable and enjoy getting to know the person and understanding how their disability affects them to ensure that the support I provide will maximise their independence and enhance their quality of life. I am a good listener and able to follow instructions. I am naturally chatty and engage easily with people to develop a good rapport. I am calm and resiliant and do not panic in a crisis. I have a strong work ethic and a lifelong approach to learning.

How do you think you can contribute towards the needs and the independence of a disabled person? *: I am kind and compassionate and use the knowledge and experience I have developed during my career and working life to provide flexible person centred support in consultation with the person I am supporting.

What is it about PA work which appeals to you? *: Knowing that I really am making a difference to someones life is a rewarding experience for me.

What are your hobbies/interests?: I enjoy cooking and baking. I love the countryside and enjoy walking my dog Millie (a boisterous Cockerpoo). I enjoy comedy festivals particularly the Edinburgh Fringe. I like to read murder/mystery/thrillers (I think I should have been a detective). Spending time socialising with family and friends.

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? *: 7

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.:

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)? *:
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 am currently on the DBS update register

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?: Birchgrove, LLanishen, Thornhill, Whitchurch, Rhiwbina, Llandaff North, Llandaff, Danescourt, Fairwater, Radyr, Gwaelod y Garth, Pentyrch, Tongwynlais, Gabalfa, Heath, Penylan

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/Saturday Overnight/Sunday AM/Sunday PM /Sunday Overnight/
Further Information: I am currently available to work with immediate effect.