Personal Assistant Application Form Submission

Title *: 

First Name *:

Last Name *: 

Address 1

Address 2:

Town *: 


County *: mid Glamorgan

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. *: Hi there my name is Laura and I have had experience of working in a care home and received a level 1 within the care sector, also Ive had personal experience of being a young carer to my mum I was quite young but looked after her but sadly she passed away, I now want the change to gain on my experience and make a change for someone else.

What qualities do you think are important when working as a personal assistant with a disabled person? *: I think you would need to have focus on the person your responsible for by undertaking what everyday things they need like bathing, dressing, feeding, going shopping for them. Being able to bond and communicate effective

ely and verbally with the person to make sure all needs are filled within the correct manor.
How do you think you can contribute towards the needs and the independence of a disabled person? *: I personally think I can really make a difference for the elderly by making sure that she has a smile each and every day Im with her helping make sure that she is comfortable with me, making sure that all the house work is done and that she is feed bathed and has fresh pajamas that I can help dress and undress her when needed, I would love to take her places if she is able to come out of the house and will play games or put something new on tv interaction is a big thing in my eyes making sure they are happy with any situation and being respectful.

What is it about PA work which appeals to you? *: I really think its a rewarding job to help others when they need or want the help and support within difficult times, I have a really warm heart and feel that I can undertake a lot of pressure and resume in a natural manor take every task and reasonability into account and make sure they are well looked after and the support is there for them.

What are your hobbies/interests?: I like to keep active so whether its cleaning to walking everyday making sure Im kept on my toes, I enjoy a good movie and can have a good chat and communicate effectively one to one or in a group, Im not much of a drinker I like to know what Im doing and just enjoy peoples company.

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 saturday days or nights

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.: All I would like too say is that Im keen to hear a response from yourself and will look forward to a phone call from yourself anything youd like too know that I havent already said I can relate to in the interview

Name *:

Job Title *: 

Address *:


Phone Number *: 

In what capacity do you know this person (should not be a family member)? *: Through friendship I have known Thomas 2 years he knows a lot about me.

Name *:

Job Title *: 

Address *: 

Phone Number *: 

In what capacity do you know this person (should not be a family member)? *:

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: N/A

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?: How many hours of work can you offer per week?: 40

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/
Further Information: