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Personal Assistant Application Form Submission  

 
Title *: Mr. 

Town *: 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. *: 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. *: All my life I have worked with people, first as a teacher and later as a customer specialist. Now I work as store specialist and delivery driver. I enjoy working with people and helping them. 

 
What qualities do you think are important when working as a personal assistant with a disabled person? *: I think empathy, patience and honest, friendly personality is vital. 

 
How do you think you can contribute towards the needs and the independence of a disabled person? *: I could help with things that a disabled person needs helping with but trying to provide independence to a disabled person as well. 

 
What is it about PA work which appeals to you? *: Close contact with a particular person, trying to help this person as much as I can. 

 
What are your hobbies/interests?: I cycle and play basketball, also like climbing mountains.  

 
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? *: Yes 

 
What days/nights are you able to work, or prefer to work? *: whenever is needed 

 
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.: I have a work part time, so I would like to work as PA or carer around it. I could resign from my current job and work full time as a PA/carer. 

 
Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? *: Yes/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 but preferred North Cardiff. 

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

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