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Personal Assistant Application Form Submission 

 
Title (required): Mr. 

Town (required): Pontypridd 
County (required): RCT 

 
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): LSA at Ysgol Glantaf Sep 2019 - Present LSA at Ysgol Llanhari Dec 2006 - Aug 2019 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Patience, understanding, empathy. 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): I am confident that I can help the independence of a disabled person by encouraging & assisting them in carrying out day to day tasks. 

 
What is it about PA work which appeals to you? (required): The opportunity to support an individual to become more independent. 

 
What are your hobbies/interests?: Sports & music. Love watching most sports, and listen to a wide range of music. Also play a little guitar/keyboards 

 
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): Monday to Friday. Some weekend days. 

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

 
If you would like to expand on the answers given above? Please use the box below.: Possibly child care, depending on the day & hours. 

 
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?: RCT, Cardiff & Vale. 

 
How many hours of work can you offer per week?: Not sure 

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