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Personal Assistant Application Form Submission 

Title: Mrs. 

Town (required): Gangetown

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): Jul 2022 – Apr 2023 Haque private care home Care and support worker v Prepare healthy and testy meals to meet dietary requirements. v Worked in close partnership with families, friends and carers to improve care plan effectiveness. v Met needs of clients with learning difficulties and handled challenging behaviours. v Monitored patient symptoms and progress to boost health outcomes. 

What qualities do you think are important when working as a personal assistant with a disabled person? (required): Empathy and Compassion, Patience, effective Communication, Respect for Independence, Problem-Solving Skills, professionalism, Physical Stamina. 

How do you think you can contribute towards the needs and the independence of a disabled person? (required): Assistance with Daily Living Activities, Mobility Assistance, Medical Care Support, Communication Support, Education and Skill Development. 

What is it about PA work which appeals to you? (required): Assistance with Daily Living, Healthcare Support, Mobility Support, Communication Assistance, Emotional Support, Accessibility and Adaptations, Educational and Skill Development, Documentation and Record Keeping. 

What are your hobbies/interests?:Reading, Outdoor Activities, Arts and Crafts, Cooking and Baking 

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

Do you speak any other languages? (required): Bangla, Hindi 

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): days 

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.: 

Do you have portable DBS (which has been paid for and renewed for the current year)? (required): Yes/ 

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): Yes/ 

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?:cardiff ,newport, 

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

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/Friday AM/Friday PM/Friday Overnight/Saturday AM/Saturday PM/Saturday Overnight/Sunday AM/Sunday Overnight/