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Personal Assistant Application Form Submission 

 
Title (required): Miss. 

Address 2: Canton 
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 worked for ProCare as a Care Assistant for elderly people. I get on well with all types of people. 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Caring, a sensible person who is responsible. Doing what the person wants, friendly and chatty if they want. Honest, respectful and hard working. 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): Helping them to do thing themselves. Doing what they need if they ask. Being nice, understanding or their needs. I like people, I like getting to know new people. 
What is it about PA work which appeals to you? (required): I like to chat, I like cooking, cleaning and ironing. I like to go for walks. 

 
What are your hobbies/interests?: I love cooking and cleaning, and spending time with my child. 

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

 
Do you drive? (required): No 
Are you a vehicle owner?  (required): No 
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): Monday- Friday 9-1pm 

 
Are there any circumstances which would prevent you from providing cover or swapping a shift? (required): Yes 

 
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?: Canton 

 
How many hours of work can you offer per week?: Up to 16 hours 

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