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Personal Assistant Application Form Submission 

 
Title (required): Mrs. 

Town (required): Cardiff 
County (required): South Wales 

 
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 work with Dewis at the moment with a gentleman who is wheelchair bound from a road traffic accident, providing personal care help around his home social aspect. Iv worked in care for 12 years. 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Punctual, respectful, caring, kind and trustworthy. 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): I’d like to promote independent living and to be as independent as possible and show equality to everyone. 

 
What is it about PA work which appeals to you? (required): It’s more laid back for the service user to make there own decisions. 

 
What are your hobbies/interests?: Gardening, walking, cleaning and socialising. 

 
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 night until Saturday am. 

 
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.: My daughter I work around her. 

 
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?: Vale of Glamorgan and cardiff. And just out of Cardiff. 

 
How many hours of work can you offer per week?: 12 over night so Friday evening until Saturday morning. 

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