Personal Assistant Application Form Submission 

Title *: Ms. 
First Name *:.
Last Name *:.
Address 1 *: .
Address 2: 
Town *: Cardiff 
County *: South Glamorgan 
Postcode *: ...
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. *: I have a bachelor’s and masters degree I own an ex-racehorse, so we have horses in common! I used to run my own music school - I am good at organising, planning and time keeping. 
What qualities do you think are important when working as a personal assistant with a disabled person? *: To be easygoing, sympathetic, proactive, to have common sense, to not be patronising and to be optimistic and encouraging. 
How do you think you can contribute towards the needs and the independence of a disabled person? *: I am happy to do anything, I’m not squeamish and I’m good company. 
What is it about PA work which appeals to you? *: I love spending time with and helping people 
What are your hobbies/interests?: Riding my horse, walking my dog, listening to music, travelling, researching things (I like learning stuff) 
Would you consider a casual position if you are unsuccessful with this job? *: Yes 
Do you drive? *: Yes 
Are you a vehicle owner? *: Yes 
Do you smoke? *: No 
Are you able to undertake training? *: Yes 
What days/nights are you able to work, or prefer to work? *: Most, I teach my students online so my schedule is flexible 
Are there any circumstances which would prevent you from providing cover or swapping a shift? *: No 
If you would like to expand on the answers given above? Please use the box below.: 
Name *: .
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?: Cardiff, Newport and the Vale of Glamorgan 
How many hours of work can you offer per week?: 20 
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/Thursday AM/Thursday Overnight/Friday AM/Friday PM/Friday Overnight/Saturday AM/Sunday AM/Sunday PM /Sunday Overnight/ 
Further Information: