Personal Assistant Application Form Submission 

 
Title *:
First Name *:  
Last Name *: 
Address 1 *: 
Address 2: 
Town *:  
County *:
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 have gained experience relevant to being a personal assistant in both my personal life, and my current employment. Since April 2005, I have been employed by Mirus-Wales in Cardiff. I support Adults with learning difficulties in their own homes, and out in the community. My main role is to empower the people I support to become as independent as possible. I offer physical, emotional, and medical support. I am at times required to assist with personal care. Some of the people I support have additional needs that require my support. This can include Epilepsy, Autism, visual impairments, mobility impairments, verbal communication difficulties, challenging behaviour, Diabetes, and a range of other medical conditions. I am required to administer medication for some of the people I support. In addition to my current employment, I have gained experience that would be an advantage as a Personal Assistant through my personal life. My younger brother has Cerebral Palsy, Epilepsy, and has learning difficulties. As well as supporting my brother to become as independent as possible, and supporting him with his physiotherapy, hydrotherapy, and operations he had as a child, I also volunteered in the school he attended. Prior to working as a Support Worker, I spent six years in the Royal Navy. My role in the Navy was a Radar operator, Gunnery, Seamanship, and maintaining the weapon systems. Although this role did not give me experience relevant to becoming a personal assistant, I believe it shows that I am a punctual person, who is reliable. Education • GCSE Psychology C • GCSE Mathematics C • GCSE English C • GCSE Commerce B • GCSE Child Development C • NVQ level 3 in health and social care. In my current employment I have carried out the following training • Epilepsy training – including Midazolam administration. • Autism Awareness • First Aid • POVA (protection of vulnerable adults) • Medication Awareness and administration • Manual Handling A-F • Food Handling • Disability Awareness 
What qualities do you think are important when working as a personal assistant with a disabled person? *: It is extremely important when being a personal assistant that you always ensure confidentiality, respect and dignity for the person you are supporting. You need to be understanding, empathetic, patient, and caring. A personal assistant needs to be honest and trustworthy, and must be reliable. They will need to be adaptable, and approachable. It is important that the person requiring assistance finds their personal assistant easy to get along with, easy to talk to, and that they feel they can trust that person. 
How do you think you can contribute towards the needs and the independence of a disabled person? *: The experience I have gained in both my personal life and my employment would be an advantage to anyone I would become a personal assistant to. I am a sociable, enthusiastic person, who is passionate about being a positive influence on a person’s life if I became their personal assistant. I have experience of acting as an advocate for people with learning difficulties and/or physical disabilities. I can be flexible in when and how I am required to work, and I have a positive ‘can do’ attitude. 
What is it about PA work which appeals to you? *: PA work appeals to me because, as I mentioned previously, I have a younger brother who has Cerebral Palsy, Epilepsy, and learning difficulties. Growing up, My Sister and I volunteered in the school that my brother attended, Trengweath School in Plymouth. We also assisted our brother in his physiotherapy sessions, and his hydrotherapy sessions, and his recovery after many operations he had as a child. Supporting our brother to become as independent as possible, and the volunteering we did in Trengweath, gave me a special passion for supporting and assisting people, and drew me towards the current employment I have now, and to apply for this position. 
What are your hobbies/interests?:I am a very active person, and really enjoy the outdoors. I enjoy stand up paddle boarding and kayaking. I enjoy ice skating and roller skating. I enjoy cycling, and am lucky enough to have the Taff Trail at the end of my garden to do this. I have a very small caravan, and enjoy spending time touring around the country. I take my bike, stand up paddle board and kayak on our caravan travels so I can enjoy all of these while away. I enjoy going to music festivals in the summer, and take my caravan to these. I enjoy going to live music concerts. I have a partner who competes in triathlons and marathons, and I enjoy travelling to support him with friends. We often combine this with a trip in our caravan. 
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? *: I am very flexible in when I work, I would prefer not to work every weekend, but am happy to work some of them. 
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 *: 
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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?: I am very flexible in areas that I can cover. I have my own car so travel would not be an issue. 
How many hours of work can you offer per week?:I am very flexible in how many hours I work. I do not have any dependents so am able to work at short notice and additional hours if required. 
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: