Personal Assistant Application Form Submission

Title *: .

First Name *: 

Last Name *: JAddress 1 *: Address 2:
Town *: Treorchy

County *: RCT

Postcode *: 


Phone number *:
Please enter your email address for submission confirmation. *: k

Reference number of job being applied for *: REF:DPC1512

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 previously worked within the care sector and undertook some training at that time but most of my knowledge and experience has come from caring for family living with mental health conditions and learning difficulties. I have both a husband and young son on the autistic spectrum and though their reactions/behaviour can be challenging on times its kept me on my feet and encouraged me to develop new strategies to help them cope in stressful situations.

What qualities do you think are important when working as a personal assistant with a disabled person? *: Understanding and the patience to understand that it takes time to get to know the person enough to understand them and their perspective.

How do you think you can contribute towards the needs and the independence of a disabled person? *: By treating them with the same respect and care Id expect my family to be given and ensuring they are given every opportunity to complete activities/tasks as independently as possible.

What is it about PA work which appeals to you? *: I previously worked within a care home and although I spent a great deal of time working with the service users individually I feel I would be able to provide a better quality of care by not dividing my attention. As a PA, the time with the service user would be focused solely on assisting them and meeting their needs.
What are your hobbies/interests?: I enjoy spending time with my family (including our variety of animals), my son isnt keen on baking but does enjoy eating the cakes and so I often do batches so we can spend some time together that isnt our usual lego. Im currently learning Welsh with my husband and am about to complete my entry level. When Im not with my family Im at a craft club I recently joined, learning to sew.

Would you consider a casual position if you are unsuccessful with this job? *: Yes

Do you drive? *: No

Are you a vehicle owner? *: No

Do you smoke? *: No

Are you able to undertake training? *: Yes

What days/nights are you able to work, or prefer to work? *: Monday to Friday, 8.30-3.30 (depending on exact location and public transport) due to child care.

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.: The only circumstance that would effect cover or shift swapping would be time to ensure I can arrange childcare.

Name *: Would prefer

Job Title *: To discuss in

Address *: person/email/phone as references

Phone Number *: currently unavailable

In what capacity do you know this person (should not be a family member)? *: Due to time taken from employment to raise my son

Name *: Would prefer


Job Title *: to discuss in
Address *: person/email/phone as references

Phone Number *: currently unavailable

In what capacity do you know this person (should not be a family member)? *: Due to time taken from employment to raise my son.

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?: RCT but the closer to Treorchy the better as I require public transport.

How many hours of work can you offer per week?: 32

Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Tuesday AM/Tuesday PM/Wednesday AM/Wednesday PM/Thursday AM/Thursday PM/Friday AM/Friday PM/

Further Information: I have taken some time away from

work in order to raise my son but am looking forward to returning to employment now hes in school. I have previously worked within the care sector, providing support for vulnerable adults suffering mental health conditions, and have extensive personal experience providing care for family suffering mental health concerns. Ideally I would like to be able to pursue training within my employment to further develop/learn skills that are crucial when working with vulnerable adults and children and would provide me with tools that would facilitate better quality care and support.