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Personal Assistant Application Form Submission  

Title *: Mr. 

Town *: Birchgrove 
County *: 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. *: I have been working as a Carer for the last 10 years. 

What qualities do you think are important when working as a personal assistant with a disabled person? *: Patience, understanding, caring, respect confidentially, punctual  

How do you think you can contribute towards the needs and the independence of a disabled person? *: Understanding the persons needs and promoting their independence 

What is it about PA work which appeals to you? *: I love seeing the service users happy and achieve their goal in life.  

What are your hobbies/interests?: Music, sports, animals and socialising with friends  
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? *: Days/evenings/weekends  

Are there any circumstances which would prevent you from providing cover or swapping a shift? *: Yes 

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 

How many hours of work can you offer per week?: 10 

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