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Personal Assistant Application Form Submission 

 
Title (required): Mr. 

Town (required): Ebbw Vale 
County (required): Gwent 

 
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. (required): 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. (required): • Assisted in administering medication in accordance with written prescriptions by health care providers. • Performed direct care including assisting with mobility, all in accordance with internal guidelines. • Provided high standard care for the elderly patients with a focus on everyday care such as personal hygiene, mental simulation and general well-being. • Liaised with other care workers on behalf of residents while ensuring that all care needs met the highest possible guidelines. • Observed and documented patient behavior, promptly reporting changes to medical staff. • Built strong relationships with patients by providing friendly and calm environments during therapy sessions. • Helped families and patients with various matters such as making meals, conducting house work and sorting paper work. 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): • Patient relations • Communication Skill • Organizational Skill • Team Player • Health Checks • Medicine Administration • Emotional Support and Companionship • Counseling 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): Seek to support and not control what people do. Try to understand what they are trying to do and give them a supporting hand. Deal with them with hope, happiness and positivity and always find ways of commending them in every little victory they achieve. Respect and recognise their wish. 

 
What is it about PA work which appeals to you? (required): PA work builds my confidence and my happiness as it makes me give positivity, hope and life to the disabled. 

 
What are your hobbies/interests?: Reading, listening to music and dancing. 

 
Would you consider a casual position if you are unsuccessful with this job? (required): Yes 

 
Do you drive? (required): Yes 
Are you a vehicle owner?  (required): No 
Do you smoke? (required): No 

 
Are you able to undertake training? (required): Yes 

 
What days/nights are you able to work, or prefer to work?  (required): Tuesdays Day time and Saturday night time 

 
Are there any circumstances which would prevent you from providing cover or swapping a shift? (required): Yes 

 
If you would like to expand on the answers given above? Please use the box below.: Days which clashes with my study days 

 
Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? (required): No/ 

 
Please provide details if necessary: 

 
I agree that there is nothing which would prevent me from doing this job. (required): Yes 

 
I consent to the above (required): 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?: 

 
How many hours of work can you offer per week?: 20 hours 

 
Please indicate the approximate times that you are available for work throughout the week.: Monday PM/Tuesday PM/Saturday Overnight/ 
Further Information: