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Personal Assistant Application Form Submission  

Title *: Mrs. 

Address 2: Pontprennau 
Town *: 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. *: 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 a QCF 2, I have worked on a dementia ward in a care home for three years, I have a mother with MS, who I have cared for and my son is Autistic. 

What qualities do you think are important when working as a personal assistant with a disabled person? *: To be kind, patient and caring and respectful of their needs. 

How do you think you can contribute towards the needs and the independence of a disabled person? *: To give them all the help they need to be independent and encouraging them to do things and be positive. 

What is it about PA work which appeals to you? *: I very much enjoy caring for people. 

What are your hobbies/interests?: I like to read and enjoy looking after our pets. I love spending time with my family. 

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? *: No 

What days/nights are you able to work, or prefer to work? *: Days, from 8.30 AM to 2.30 PM occasionally longer. 

Are there any circumstances which would prevent you from providing cover or swapping a shift? *: 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? *: No/ 

Please provide details if necessary:  

I agree that there is nothing which would prevent me from doing this job. *: Yes 
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?: pentwyn, Roath, Llanedeyrn, PontprennaullanishenCyncoed. 

How many hours of work can you offer per week?: 14 
Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Tuesday AM/Wednesday AM/Thursday AM/Friday AM/Saturday AM/ 
Further Information: early afternoon also.