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Personal Assistant Application Form Submission 

 
Title (required): Mr. 

Address 2: Ponprennau 
Town (required): Cardiff 

 
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): I have been a single father for 4 years who has great patients and punctuality. I am well travelled and physically fit. I teach martial arts so I’m very disciplined. 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Understanding your clients needs, patience’s and great communication 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): Help them with life Skills, Confident building and just trying to make them happy 

 
What is it about PA work which appeals to you? (required): Confident building and just trying to make them happy. 

 
What are your hobbies/interests?: Gardening, karate, walking the dog and DIY 

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

 
Do you drive? (required): Yes 
Are you a vehicle owner?  (required): Yes 
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): Any 

 
Are there any circumstances which would prevent you from providing cover or swapping a shift? (required): No 

 
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): No/ 

 
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 

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

 
Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Tuesday AM/Wednesday AM/Thursday AM/Friday AM/Saturday AM/ 
Further Information: Hours can be Change to suit you