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Personal Assistant Application Form Submission 

 
Title (required): Miss. 

Town (required): Cardiff 
County (required): south glam 

 
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): Whitchurch high school Cardiff GCSE levels: Maths (A) English (B) Technology (B) Science (C) P.E(C), Art(A) Child care-(A) Barry College of F.E -BTEC Social Care- 1990 –1992 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Show care for the service user by interacting with and listening to them, I always consider the person as an individual and respect there privacy. deliver quality care in a way that they’re comfortable with, and set boundaries and comply with their requests, which can help to reduce unnecessary anxiety as well. I think friendly attitude can ensure that they feel happy and safe in my presence. Always making sure the person keeps there dignity with any personal care. 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): Empower the person I am working with to make decisions and actively involve them in decision-making. Be positive and celebrate small improvements. encouraging independence in the community. Introducing certain aides around the house, to encourage independence. 

 
What is it about PA work which appeals to you? (required): I really enjoy the one to one aspect of PA work, and building a relationship and continuity. 

 
What are your hobbies/interests?: I have a small dog which I walk regularly usually at the Brecon Beacons. I am also a keen cook with my own Facebook food page, and also have a keen interest in a keeping a healthy lifestyle by cycling and attending the gym. 

 
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 day and sleep in. 
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, Vale, RCT 

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

 
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/Wednesday PM/Wednesday Overnight/Thursday AM/Thursday PM/Thursday Overnight/Friday AM/Friday PM/Friday Overnight/Saturday AM/Saturday PM/Sunday AM/Sunday PM / 
Further Information: