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Personal Assistant Application Form Submission 

Title (required): Mrs. 

Address 2: Cardiff Bay 
Town (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): Back home, I worked part time with a care home called Hephzibah Care Home as a health care support assistance. My responsibilities are listed below: n Acts as support to nurses, clients and families that visits our facility n Provide companionship to clients n Administer medication under supervision n Provide weekly progress report and general report n Documentation of care given and care need n Provide personal care, support and hygiene for residents 

What qualities do you think are important when working as a personal assistant with a disabled person? (required): Important qualities of a personal assistant when working with a disabled person are as follow - The person must be caring, empathetic and kind - A good listener - Good communication skills - Professional and reliable - Flexible and willing to adapt to the persons need - A good PA must be able to provide support _ A good PA must be a good companion, that is provide companionship - A good PA should be happy to support a disabled person when he/she is doing the things that makes them happy. 

How do you think you can contribute towards the needs and the independence of a disabled person? (required): I will interact with the client to understand where I am needed the most I will respect the persons dignity while attending to his/ her needs. Provide essential emotional support, comfort and companionship Accompany the client on outdoor activities for instance exercise and walk 

What is it about PA work which appeals to you? (required): The thing about PA work that appeals to me is that I am happy to provide support. I love the fact that I am helping someone achieve what he wants to achieve during the period I am around. I am passionate about helping people, this makes the world in general a better place for everybody. 

What are your hobbies/interests?:I love dogs as pet and I like to listen to music 

Would you consider a casual position if you are unsuccessful with this job? (required): Yes 

Do you drive? (required): No 
Are you a vehicle owner?  (required): No 
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): I prefer to work anytime on Mondays, Saturdays and Sundays and then night shift on Tuesdays to Friday 

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.:This is because of school as I am an international student and the days and time listed are my free periods. 

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?:Cardiff 

How many hours of work can you offer per week?:20 hours 

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