Personal Assistant Application Form Submission 

 
Title *: . 
First Name *: 
Last Name *:
Address 1 *: 
Address 2:
County *: Cardiff 
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. *: I’ve worked in a care home for two years with dementia patients ,I was my mums carer for 10 years .i don’t have a lot of experience with brain injury but I’m willing to learn more about the effects it has on people. 
What qualities do you think are important when working as a personal assistant with a disabled person? *: Being patient kind caring and compassionate while helping them try and lead the best life they can . 
How do you think you can contribute towards the needs and the independence of a disabled person? *: I’m very caring I loved everything about being my mums carer ,I always encourage her to be out and about doing the things she loves but also mindful that she didn’t push her self to much but still keep her independence. 
What is it about PA work which appeals to you? *: I really like to help people ,to me it does not feel like a job It’s a pleasure to be able to help make there day that little bit better. 
What are your hobbies/interests?:I love to ride my bike going out for long walks and being with my family is the best place in the world. 
Would you consider a casual position if you are unsuccessful with this job? *: No 
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? *: Monday Tuesday Wednesday Friday Saturday or a Sunday any time 
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.:There is one day a week that I care for my grandchildren it would be a Thursday 
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 and vale 
How many hours of work can you offer per week?: 30 
Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Tuesday AM/Tuesday PM/Wednesday AM/Wednesday PM/Friday AM/Saturday AM/Saturday PM/Sunday AM/Sunday PM / 
Further Information: