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Personal Assistant Application Form Submission 

 
Title (required): Mrs. 
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): I have done something similar in Nigeria 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Caring, patient and friendly 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): Ready to help and give assistance at all times 

 
What is it about PA work which appeals to you? (required): Helping to to manage and organize schedules for an individual 

 
What are your hobbies/interests?:Reading. Dancing and reaching out to people 

 
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): Night shifts 

 
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 am a student and wont be available on the hours I am attending lectures 

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 and environs 

 
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 PM/Tuesday AM/Tuesday PM/Wednesday PM/Thursday AM/Friday PM/Saturday AM/Saturday PM/Sunday AM/Sunday PM / 
Further Information: