Personal Assistant Application Form Submission


Title *: Mr.


First Name *: 


Last Name *: 


Address 1 *:


Address 2: Cwmbach


Town *: Aberdare


County *: Rhondda Cynon Taff


Postcode *:
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. *: Currently supporting an Acquired Brain Injury client, out in the community and within the home. Also Housing support for clients of all ages/backgrounds, within a residential setting. Although only recently returned to the Social Care/Work sectors, I have a vast and varied experience in several disciplines, throughout the social care/work and support environment. Started as a primary carer for my late brother, who was diagnosed with Multiple Sclerosis in the late 80s. This influenced me to help others and branched off supporting Stroke, mental health, learning difficulties, acquired brain and spinal injuries for clients of all ages and backgrounds. Heavily involved within various Social Services, supporting parents and children to prevent breakdown, by using a Therapeutic approach. Writing care plans, budgeting, goal setting, occupational and risk assessments, attending meetings, liaising with other professionals and other tasks that may not be job related.


What qualities do you think are important when working as a personal assistant with a disabled person? *: Respect all values and dignity, be a good listener and very understanding and sympathetic. Be professional and non judgemental and always ensure safety at the highest level.


How do you think you can contribute towards the needs and the independence of a disabled person? *: Being a very good listener, I can adapt to any situation and fully understand the needs and requirements regarding each individual. Happy to motivate and encourage individuals to meet their wins and gains and most importantly, without making the situation feel uncomfortable.


What is it about PA work which appeals to you? *: It has always been a massive buzz to put a smile on someone’s face.


What are your hobbies/interests?: All genres of music, most sports, true documentaries, being out and about, drive in the car, walking, love my 2 little pooches.


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? *: flexible


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. Although mainly covering night shifts, I have the flexibility to choose and prioritise my work load.


In what capacity do you know this person (should not be a family member
If there is any such information you wish to provide? *: Yes


Please provide details if necessary: 1986: Actual Bodily Harm. Playing around with my cousins Air Riffle, which accidentally went off and hit a friends leg. While back in school, he went to see the school nurse for pain killers and explained what happened. The Police were notified and although no skin had been broken and no blood was visible, the Police perused with the arrest. My friend and his family insisted on no action to be taken, but the Police took the case to court. I was given a 2 year probational period. See my online portal DBS.
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,and surrounding areas within 15 miles.


How many hours of work can you offer per week?: flexible


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/Sunday Overnight/
Further Information: N/A