Personal Assistant Application Form Submission 

Title *: . 
First Name *: 
Last Name *: 
Address 1 *: 
Address 2: 
Town *: Cardiff 
County *: South Glamorgan 
Postcode *: 
Phone number *: 
Please enter your email address for submission confirmation. *:  
Reference number of job being applied for *: DP002 Personal care assistant Hawthorn 
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 with vulnerable people who need support in their daily life,such as washing,dressing (Personal hygiene)feeding and general engagement and looking after their needs 
What qualities do you think are important when working as a personal assistant with a disabled person? *: To be compassionate, understanding and willing to go the extra mile 
How do you think you can contribute towards the needs and the independence of a disabled person? *: By assisting in in any way I can and allowing them to do more for themselves but also supporting them to make that they are safe 
What is it about PA work which appeals to you? *: I enjoy helping others and if I have helped in a good and productive way, I feel its rewarding. I 
What are your hobbies/interests?:Swimming, cooking and travelling 
Would you consider a casual position if you are unsuccessful with this job? *: Yes 
Do you drive? *: No 
Are you a vehicle owner? *: No 
Do you smoke? *: No 
Are you able to undertake training? *: Yes 
What days/nights are you able to work, or prefer to work? *: Friday and Saturday nights 
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.: 
Name *: 
In what capacity do you know this person (should not be a family member)? *: Work colleague 
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 RCT
How many hours of work can you offer per week?: 24 
Please indicate the approximate times that you are available for work throughout the week.: Friday Overnight/Saturday Overnight/ 
Further Information: