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Personal Assistant Application Form Submission  

 
Title *: Miss. 

Town *: HENGOED 
County *: Caerphilly 

 
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 worked in the care sector for 12 years I have worked in different roles in the sector  

 
What qualities do you think are important when working as a personal assistant with a disabled person? *: kind,friendly and patience  

 
How do you think you can contribute towards the needs and the independence of a disabled person? *: Im very patient Im quite quiet so I feel I have a calming effect with others  

 
What is it about PA work which appeals to you? *: I enjoy helping others and helping them achieve their goals  

 
What are your hobbies/interests?: Bike riding,walking my dogs and watching tv  

 
Would you consider a casual position if you are unsuccessful with this job? *: Yes 

 
Do you drive? *: Yes 

 
Are you a vehicle owner? *: Yes 

 
Do you smoke? *: No 

 
Are you able to undertake training? *: Yes 

 
What days/nights are you able to work, or prefer to work? *: Monday all day ,tuesday intill 3pm ,Wednesday all day and either Thursday or a Friday all day  

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

 
If you would like to expand on the answers given above? Please use the box below.: Cant do weekend due to looking after another gentleman And Tuesday evening  

 
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. *: No 

 
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?: Caerphilly Cardiff Vale of Glamorgan Blaenau  

 
How many hours of work can you offer per week?: 30 

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