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Personal Assistant Application Form Submission 

Title (required): Ms. 

Address 2: Fairwater 
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): Lifting and handling, food hygiene, first aid and medication course. 

What qualities do you think are important when working as a personal assistant with a disabled person? (required): A very good listener and adaptable. 

How do you think you can contribute towards the needs and the independence of a disabled person? (required): Be patient, give support and encouragement. Helpful, keeping them safe, comfortable. 

What is it about PA work which appeals to you? (required): Helping others, supporting others needs. Satisfaction in my work. 

What are your hobbies/interests?: Football, rugby, bike riding, gym, boxing. 

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): Friday/ Wednesday 

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

If you would like to expand on the answers given above? Please use the box below.: 

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?: 16 hours 
Please indicate the approximate times that you are available for work throughout the week.: 
Further Information: