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Personal Assistant Application Form Submission  

 
Title *: Miss. 

Address 2: Rumney  
Town *: 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. *: 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 previous experience in care and I currently have 1 other client. I have no current experience working with dementia patients but I feel that this job will give me a little experience as well as giving the client the perfect companion. I love to cook and clean so domestic duties would never be a problem.  

 
What qualities do you think are important when working as a personal assistant with a disabled person? *: I think the qualities that are important would be to be a friendly person, a trustworthy person and a patient l, kind and compassionate person.  

 
How do you think you can contribute towards the needs and the independence of a disabled person? *: I feel I could help this client live as independent as possible as I am a trustworthy kind compassionate individual who is patient and always friendly. 

 
What is it about PA work which appeals to you? *: I think being a P.A appeals to me as I love to help everyone I also love to give people the confidence to be independent in and out of the home. 

 
What are your hobbies/interests?: My hobbies and interests would be cooking, cleaning, walking and owning dogs 

 
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? *: Yes 

 
Are you able to undertake training? *: Yes 

 
What days/nights are you able to work, or prefer to work? *: Weekdays and weekends I’m available. 

 
Are there any circumstances which would prevent you from providing cover or swapping a shift? *: 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? *: 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?: Trowbridge Llanrumney Rumney St Mellon’s Llanishen 

 
How many hours of work can you offer per week?: 10 

 
Please indicate the approximate times that you are available for work throughout the week.: Tuesday AM/Tuesday PM/Thursday AM/Thursday PM/Friday AM/ 
Further Information: