[For OACP use only] Approval Number APP/SWC/PA/185/0317
To be added to the approved Support with Confidence Personal Assistant listings, all of the information must be provided. Checks will be carried out to verify it. The details in the bold boxes will make up your public profile and will be displayed to the public on the OACP website.
Title Mr Mrs Miss X Ms Dr Prof
Your Full Name
First Name Emma
Family Name Lane
Gender Male Female X
Mobile 07577456173
Email [email protected]
Date of last DBS check, or state never 11/12/2015 Relevant training undertaken and dates
Course type Completed 1. Safe administration of medication 30/07/2014 2. Cri du chat syndrome 07/08/2014 3. Emergancy first aid at work 14/08/2014 4. Person centred planning course 20/08/2014 5. Epliepsy 21/08/2014 6. Fire awareness 16/07/2014
1 | P a g e 7. Safegaurding adults 20/08/2014 8. Food safety 06/08/2014 9. Falls workshop 17/07/2014 10. Infection control 30/07/2014
11. Personalisation 21/08/2014
12. Moving & handling 17/07/2014
13. Health & safety awareness 16/07/2014
14. NVQ Health & Social Care Level 2 (Specialist in Learning Disabilities) 2013
15. NVQ Health & Social Care Level 2 (Childcare and Education) 2009 Car Driver Yes X No
Approximate charges:
Per hour 8am – 8pm Monday to Friday £16.00 Per hour 8am – 8pm Weekends and Bank Holidays £16.00 Per hour 8pm – 8am Overnight care £45.00 sleep over Per task if appropriate £
Short description about you – max 100 words [a summary of your personal qualities] I am kind, caring, hard working, patient person that likes to give 100% in all that I do, but I can be firm when necessary. I like to try new activities and get out and about as much as possible. Im a confident driver and have a OCC driving permit for a mini van. Over my 6 years experience I have worked with a lot of people with a wide range of disabilities in varies settings such as day centres, supported living & lone working. Before becoming a support worker/pa I was a childcare practioner and have a nvq 2 in childcare. I also have got a nvq 2 in health & social care.
2 | P a g e Which tasks are you interested in doing as a Personal Assistant? Personal care X Social & Leisure activities X Domestic Assistance X Work or study support X Other, please state
3 | P a g e Which area[s] are you planning to work in?
Tick Postcode Including Alkerton, Balscote, Barford St Michael, Barford St John, Bloxham, Bodicote, Brailes, Broughton, Deddington, Hempton, X OX15 Drayton, Edge Hill, Epwell, Hook Norton, Horley, Hornton, Milcombe, Milton, North Newington, Ratley, Shenington, Sibford Ferris, Sibford Gower, Shutford, South Newington, Swalcliffe, Swerford, Tadmarton, Upton, Wigginton, Wroxton, X OX16 Banbury Adderbury, Appletree, Aynho, Arlescote, Chacombe, Charlton, Cheney, Chipping Warden, Claydon, Cropredy, Culworth, Edgcote, Farnborough (Warks), Greatworth, Great Bourton, Hanwell, King's Sutton, Little Bourton, Lower Thorpe, Marston X OX17 St Lawrence, Middleton Mollington, Nethercote, Newbottle, Overthorpe, Prescote, Shotteswell, Stuchbury, Sulgrave, Thenford, Thorpe Mandeville, Twyford, Upper Astrop, Wardington, Warkworth, Warmington, Williamscott
4 | P a g e On which days and times would you like to work? Add specific hours if needed.
Day Morning Afternoon Evening Night
Monday any any any Sleep overs only
Tuesday any any any Sleep overs only
Wednesday any any any Sleep overs only
Thursday any any any Sleep overs only
Friday Any any any Sleep overs only
Saturday any any any Sleep overs only
Sunday any any any Sleep overs only
5 | P a g e