Personal Assistant Application Form Submission 

Title *: 
First Name *:  
Last Name *: 
Address 1 *: 
Address 2: 
Town *: Cardiff 
County *: N/A 
Postcode *:
Phone number *: 
Please enter your email address for submission confirmation. *: 
Reference number of job being applied for *:  
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. *: Am currently working as a Team leader in a Domiciliary care sector.I have hard an opportunity to provide care for different people of different age range with different needs.I pride myself to be a warm and caring person who takes values if care seriously and believes that every individual should be care for in a personal centred way. 
What qualities do you think are important when working as a personal assistant with a disabled person? *: -Patience -Being reliable -Being a happy and cheerful person -dependable -Trustworthy -ability to show respect -Ability to listen and understand the client to offer a personal -delivering a personal centred care 
How do you think you can contribute towards the needs and the independence of a disabled person? *: -Allowing the Client to take a lead on how they want to be cared for -Being practical to help -offering flexible communication skills 
What is it about PA work which appeals to you? *: -I have empathy and genuinely like to meet people and offer help where i can.I believe in people having equal opportunity to get about to do what they want to do.Am hardworking and reliable and trustworthy. 
What are your hobbies/interests?:reading,travelling, Music and watching Documentaries 
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? *: Any night Monday to friday 
Are there any circumstances which would prevent you from providing cover or swapping a shift? *: No 
If you would like to expand on the answers given above? Please use the box below.: 
Name *: 
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?: Cardiff and pernarth 
How many hours of work can you offer per week?: 25 
Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday Overnight/Tuesday AM/Tuesday Overnight/Wednesday AM/Wednesday Overnight/Thursday Overnight/ 
Further Information: