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Personal Assistant Application Form Submission 

 
Title (required): Miss. 

County (required): 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. (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 have extensive experience working with in a health care environment for both the elderly and adults with disability I am a fun outgoing individual. 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): good communication skills, being person centred and able to adapt to your surroundings. A good understanding of the persons disability. 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): I am an organised person and able to be proactive in my work. I am very open minded and able to be person centred in my approach to tasks. I hold a full licence and have my own car 

 
What is it about PA work which appeals to you? (required): being able to have a positive impact on the person that i am working with and helping to make somes life as independent as possible 

 
What are your hobbies/interests?: I love to sing and socialise, i enjoy films and tv box sets. I like to walk and love to travel when possible. 

 
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): Yes 

 
Are you able to undertake training? (required): Yes 

 
What days/nights are you able to work, or prefer to work?  (required): i am flexible with the hours that i can work 

 
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.: I have a small child so it may be difficult at times to provide cover at short notice 

 
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/ 

 
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?: Cardiff, Barry, Penarth 

 
How many hours of work can you offer per week?: 16 

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